georgia department of public health
annual
report
1961--1962

State of Georgia

Department of Public Health

JOHN H. VENABLE, M. D., DIRECTOR

47 TRINITY AVE.

ATLANTA 3, GEORGIA

The Honorable Carl E. Sanders Governor of the State of Georgia State Capitol Atlanta 3, Georgia Dear Sir:
It is my privilege to submit this Annual Report on behalf of the Board of Health. The report, covering the period July 1961 through June 1962 in which S. Ernest Vandiver was Governor, has been delayed because of numerous personnel changes.
There have been many program changes, expansions and additions within this period. The expansion of local public health programs continues to be a major objective of the Department, with approximately one-third of the Department's available funds being used for direct assistance to counties for public health programs.
The Health Department, with all state agencies, is operating in a period where transition and change are the norm rather than the exception. We are benefitting from the tremendous scientific break-through initiated by World War II and continuously expanded in the years that followed the war's end. With the new scientific advances have come new problems, problems that did not exist a few short years ago.
As our laboratories modify and expand new techniques to prevent and combat disease through scientifically precise means we cannot ignore the less precise health problems of man in relation to his environment. The health

picture is becoming the total human picture. Health workers must respond to this challenge by enlarging their individual skills. Physicians, nurses, sanitarians, health educators, public health engineers and all allied health disciplines are working in new areas, areas increasing in complexity.
As Georgia grows in human and industrial population, air and water long taken for granted - become areas of increased health concern. International tensions, relaxed and then tightened, increase civil defense health responsibilities. Improved standards of living - diet, preventive medicine, new medications - are expanding our man power pool to include older citizens, still active and potentially productive. The mentally disturbed, once relegated to institutional custody, are returning to useful lives through growing scientific knowledge and growing public understanding of their problems. Infants and the young must reach their full potential with healthy minds and bodies.
The traditional dividers between physical health and environmental health and mental health are becoming less well defined. Our goal must be maximum good health for all. The longer lives that science is providing us must be fruitful and productive.
It is important that public health not limit its concern to new and emerging frontiers. It must also be concerned with maintaining surveillance over the older diseases if we are to enjoy total good health and all it means to productivity and to continued economic, social and personal development.
<tL Respectfully, 1-f. Ll"-, .4.., ,.,.
John H. Venable, M.D. Director

TABLE OF CONTENTS

DIVISION OF ADMINISTRATION AND FINANCE

Health Education and Training Service

1

Personnel Service . .

4

Vital Records Service

6

Patient Accounts Unit

8

DIVISION OF PHYSICAL HEALTH

Branch of Dental Health

Branch of Dental Health

9

Dental Public Health Service

12

Envirorunental Health Branch

Housing Hygiene and Accident Prevention Service

16

Industrial Hygiene Service . . . .

19

Public Health Engineering Service

21

Water Resources Service ...

26

Health Conservation Branch

Crippled Children's Service

29

Maternal and Child Health Service

31

Nutrition Service

34

School Health Service

36

Laboratory Branch Laboratory Services . 39

Local Health Branch

Local Health Administration Service

45

Public Health Nursing Service



47

Northern Health Region

50

Central Health Region

53

Southern Health Region

55

Preventable Diseases Branch

Cancer Control Section

58

Cardiovascular Disease Control Service

61

Epidemiology Service

65

Georgia State Employees Health Service

69

Occupational Health Service

72

Tuberculosis Control Service



74

Venereal Disease Control Section

77

Veterinary Public Health ..

79

Special Services Branch

Battey State Hospital

81

Hospital Services

84

DIVISION OF MENTAL HEALTH

Alcoholic Rehabilitation Service.

88

Community Mental Health Service.

91

Gracewood State School and Hospital

94

Milledgeville State Hospital

99

SPECIAL PROGRAMS

Civil Defense Health Services.

103

Geriatrics Program

105

Division of Administration and Finance

HEALTH EDUCATION AND TRAINING SERVICE
Health Education Program - Health education personnel have continued to offer consultant help in educational methodology and techniques and in the preparation of materials to state, regional, district and local health personnel. Additional major activities included working with other state and voluntary agencies, school systems, the University System and Emory University, in special educational projects, material and curriculum development, and general consultation. At the time of this writing, there are empty. but budgeted, positions available.
Training Section - Training contracts with Bibb, DeKalb, Fulton, Muscogee and Richmond Counties continued in force. Each of these counties served as field training centers for nurses. Fulton and Bibb Counties also accepted sanitarians. A contract was signed with Walker County to serve as a training center for both nurses and sanitarians; this was scheduled to go into effect in July of fiscal 1962. The contract for nurse field training with Emory University continues in effect. Additional negotiations to provide for an Emory University faculty member in the training center were completed with Emory University and Fulton County Health Department.
One hundred short-term in-service training courses were given to approximately 893 state and local staff members. Twenty-three visitors from 14 countries spent one day to several weeks visiting the state and
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local health departments.

The following table summarizes stipend-supported training:

Administr ator Dietary Consultant Engineer Health Educator Industrial Hygienist Instructor, Elementary School Nurse Physician Psychologist Psychology Intern Sanitarian Social Worker Environmental Sanitation Short Course

Academic
1 1 1 2 0 3 1 0 2 4 1 5 20

Orientation
0 0 2 0 1 0 42 3 0 0 1 0 0

Public Information Program - General health information, touching most of the Department's programs at the state and local level, was disseminated to the general public using all available media: newspapers, magazines (general interest and technical publications), television and radio. Contacts were established to utilize the specialized techniques of educational television, including WGTV in Athens.
Specific health projects which engendered unusual public interest were polio immunization, water quality, mental health and fluoridation.
GEORGIA'S HEALTH, a monthly publication aimed at both the general public and professional people, and FAX for health workers were used to augment the public media.
Working with various other services, Public Information also assisted in preparations for fairs, demonstrations, workshops and seminars.
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These responsibilities included design and construction of exhibits, preparation of printed programs, photography, art work and the use of audiovisual equipment.
Publications including pamphlets, brochures and the Annual Report were also used to supplement program coverage by public media. Liaison with the information units at Gracewood State School and Hospital, Milledgeville State Hospital and Battey State Hospital helped to keep the public informed of institutional public health programs.
Library - During the past year, the library has served both public health workers and the general public in numerous ways. Among these were the addition of 337 new books; the circulation of 9, 567 publications; answering 898 reference questions; filling 300 requests for Xerox copies of reference material; borrowing 221 books or journals through interlibrary loan service; searching resource material for current information concerning topics of special interest in developing programs and projects and introducing new personnel to the library - its facilities, resources and services.
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PERSONNEL SERVICE A net gain of 118 employees brought the number of full-time personnel in classified positions in public health to a total of 5, 761 as of June 30, 1962. Almost half of these employees are caring for the more than 12, 000 patients at Milledgeville State Hospital. Local health departments (including Fulton County Health Department, which is served by the Fulton County Civil Service) actually have more than the 1, 226 employees shown in classified positions, since many counties employ additional per sons paid entirely from local funds. Included in the nearly 6, 000 full-time employees are 142 physicians, 19 dentists, 725 nurses, 15 psychologists, and 26 social workers. Two hundred and forty-eight engineers and sanitarians are working with environmental health. Professional workers in many other fields also render full-time services and the program benefits by the part-time and occasional services of many other professional consultants. During the year the pay plan was adjusted to take into consideration the constantly rising cost of living. A health insurance plan for all full-time employees of the State of Georgia was set up and became effective July 1, 1962.
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FULL-TIME EMPLOYMENT

June 30, 1961

Local Health Departments Fulton County Health Department Alcoholic Rehabilitation Service State Health Department Battey State Hospital Gracewood State School and Hospital Milledgeville State Hospital
Totals

>~896
307 43
*641 774
*436 2546
5643

~~ Adjusted to show later information

June 30, 1962
916 310
43 687 781 479 2545
5761

EMPLOYMENT TURNOVER June 30, 1962

Appointments Separations Net Gain Separation Rate

Local Fulton A. R. S. State Battey Gracewood Milledgeville

155 45 8
243 153 122 440
1166

135

20

42

3

8

0

197

46

146

7

79

43

441

-1

1048

118

15% 14% 19% 30% 19% 17% 17%
18%

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VITAL RECORDS SERVICE
During the fiscal year ending June 30, 1962, a total of 277, 370 records representing 224, 392 vital events were processed and recorded in the Vital Records Service. The events recorded were 99, 768 current live births, 35, 355 deaths, 3, 485 fetal deaths, 52, 978 marriages, 9, 307 divorces, and 23, 499 birth certificates filed by the delayed procedure.
A total of l, 385 children born out of wedlock were legitimated during the year and four were delegitimated. New birth certificates were processed and filed for these children. Adoption orders for 2, 471 children were received and processed. New birth certificates were filed for l, 996 of these children.
Superior court orders changing the legal names of 135 people were received and the birth certificates were amended in accordance with these orders. Over 7, 500 court orders to correct or amend errors in birth and/or death certificates were received, processed, and filed.
During the year 39, 311 certified copies of birth and/or death records were issued and more than 100, 000 verifications of birth and/or death were made to parents, schools, welfare, and other governmental and private agencies.
Microfilming the various records on file in the service has not proceeded as rapidly as hoped due to the difficulty in maintaining an adequate staff; however, considerable progress was made. Many technical
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problems involving the quality of film images of records obtained and the ability to reproduce these film images arise in a program of this type. These problems must and have been faced as they appear to the end that a maximum use of microfilm in the place of the original records will be possible.
An internal reorganization of the service was begun during the year. This reorganization made it possible to render a more rapid and efficient service to the public.
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PATIENT ACCOUNTS UNIT
Working with the Department of Revenue the 1960 income tax returns on thousands of individuals were checked to determine the ability of the patient or other responsible persons, to pay some amount towards the cost of care and treatment of persons in institutions under the control of the State Health Department. Many letters have been written, telephone calls made and interviews conducted to determine the amount to be paid.
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Most of the responsible persons are anxious to make payment for the patients but a few refuse and have requested the Hearing Officer to listen to their problems.
Invoicing and collecting for Battey State Hospital was transferred to this unit in September, 19 61 and the Alcoholic Rehabilitation Service in January, 1962. There was an increase of 141% in the amount collected at Gracewood and an increase of 69% at Milledgeville over the previous fiscal year. The number of patients having the ability to pay is still small, seven per cent at Milledgeville and l 7% at Gracewood. The number paying at Battey, excluding those who have hospital insurance, is still very small. This is also true with the Alcoholic Clinics. More insurance companies are adding these diseases to their policies and as patients enter the institutions these companies should pay.
In August, 1961 regular accounts were placed on IBM punch cards, making invoicing more simple. Due to some patients entering and leaving the institutions daily, much of the billing still has to be done by hand.
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Division of Physical Health

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dental health branch

BRANCH OF DENTAL HEALTH
Plans for the second year of the biennium anticipated an expansion in prevention, education, remedial and training services. The plans included provision for a clinical dental consultant and a dental hygiene consultant to be added to the staff.
The new State Budget Act of 1962 which required advanced program and budget planning can be a serious obstacle to the implementation of emergency programs or to the inaugration of desirable services that are not included in the budget.
In 1962 for the first time, the three regional dental consultant positions were filled. Progress of the total dental program is reflected in their relationship with the dental profession, local health departments and in their many community activities. There is a need, however, to establish a clinical dental service and to activate the dental public health service. The director positions of these two services need to be established and filled with qualified personnel.
There are five full time public health dentists in district and local health departments, two of which are district directors of dental public health. Institutional dentists include eight at Milledgeville, three at Gracewood, and one full time and one part time at Battey. However, the positions at Milledgeville and Gracewood were fully staffed for only part of the year.
The shortage of dentists in Georgia continues to prevent the full
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staffing of public health dental clinics and institutional dental programs. Georgia ranks 46 in the nation with regard to the dentist-population ratio.
Some interest has been shown in expanding dental school facilities in the State; however, there is a need also for a scholarship program to support the dental school training for qualified candidates who otherwise will not be able to enter the profession. There is also a need for training facilities both for dental hygienists and dental assistants. No accredited facility for such training exists in the State.
The staff of the Branch of Dental Health conducted two accredited courses for the senior dental students at Emory University School of Dentistry: (one) a 16 hour course in public health, and (two) a 16 hour course in civil defense. The latter course included eight hours of the students 1 presentation of the medical self-help lectures.
Two dental students and one recent dental graduate received general orientation in public health including experience in the dental survey conducted at Milledgeville State Hospital.
In accordance with the established policy, professional and technical direction were provided to Milledgeville, Gracewood and Battey State Hospitals in the planning and operation of the dental programs. Staffing problems continue to exist in Milledgeville, especially the problem of maintaining the necessary complement of dentists throughout the year due to the short time and indefinite period of their employment.
In order to plan more precisely for a program to meet the re-
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sponsibilities for dental care services at Milledgeville, a survey of the dental needs of a sample of the institution's population was made. On the basis of detailed clinical dental examinations of l, 048 patients and prisoners, a plan is being completed including recommendations for personnel needs and treatment priorities. Employees and their dependents continue to utilize approximately one -fourth of the professional time of the dentists.
Plans are being made for an evaluation of the dental program at Battey State Hospital, and perhaps at Gracewood during the next year.
Upon the recommendation of a committee from the State Board of Health, the Local Health Branch contracted with District 28 to conduct a demonstration for the purpose of evaluating the potential of a full time dental director in extending and intergrating dental health services in the total district health program. Very favorable reports have been made during the first year of this project. A comprehensive evaluation will be made at the end of a two year period.
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DENTAL PUBLIC HEALTH SERVICE
Consultation and technical assistance were provided to local health departments, and to professional and community groups in the promotion of dental health. The Service continued to emphasize the importance of community water fluoridation, incremental dental care for children, and continuous dental health education.
Preventive Services - Communities were encouraged to fluoridate their public water supply. Those communities fluoridating were urged to maintain fluoride in sufficient concentration to help insure effective protection against dental caries.
Dental surveys, made in DeKalb County and in Athens after ten years of fluoridation and in Griffin after seven years, added evidence of the benefits of fluoridation. These studies pointed out the advantage of adding fluorides in sufficient amounts recommended by the Georgia Department of Public Health. The DeKalb report, which involved the findings of more than 13, 000 children, was prepared for publication in the Journal of the Georgia Dental Association. The Griffin study was submitted for publication in Public Health Dentistry, the official bulletin of the American Association of Public Health Dentists. Four additional water systems began fluoridating which brought the State total up to 46 fluoridated public water supplies serving more than 1, 076, 171 people in 108 communities and rural and suburban areas.
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Base line dental surveys were made in Toccoa and Thomaston soon after fluoridation began for the purpose of obtaining data for future evaluation of the programs.
Regional dental consultants provided consultation and technical assistance to district dental directors, local health departments, and dental societies in programs for prevention of dental injuries in contact sports. This program involves the fabrication of individually fitted mouth protectors for scholastic athletes who engage in such sports.
Remedial Services - Dental care services for underprivileged children were provided in public health dental clinics in 71 counties. These services were provided by five full time public health dentists and 245 private dental practitioners on a part time basis. New facilities were installed in two counties; clinics were started or reactivated in seven. Nevertheless, because of the shortage of dentists or lack of local funds, 35 clinics failed to operate. Several continued to operate on a nine month instead of a 12 month basis.
Education and Training Services - Continuous dental health education is a program goal in promoting the utilization of effective preventive dental health procedures. All staff members contributed to the educational program through (1) consultation and assistance to public health personnel, dentists, schools, colleges, teacher education classes, official and voluntary agencies; and (2) selection and preparation of educational resources such as pamphlets and audio-visual aids.
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Annual observance of National Children's Dental Health Week in February continued to increase the demands for dental health education services and materials.
Special Projects - A State-wide survey of dental x-ray machines was begun with the cooperation of Industrial Hygiene Service, local health departments, Georgia Dental Association and the U. S. Public Health Service. The first phase of the program consisted of locating the x-ray units and testing them through the use of a new method known as the Surpak. The Surpak is a sensitive sheet of film which when processed reveals the status of collimation and filtration. Although the program was a voluntary one, more than 1, 200 dental x-ray units were registered with the cooperation of almost 900 private dental offices, institutions, hospitals and clinics. The objective of this program is to reduce to a minimum the amount of radiation used in dental diagnoses without curtailing the use of dental x-rays or sacrificing quality of the films. Phase II of the program will consist of a follow-up with office visits and evaluations. Collimators and filters will be furnished for those machines needing modification.
The film badge survey of a limited number of dental offices done previously was reported in the Spring issue (1962) of Public Health Dentistry.
A docu-drama on fluoridation, a new audio-visual method designed to promote action on fluoridation has been developed with the Georgia
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Center for Continuing Education under the sponsorship and technical direction of the U. S. Public Health Service and the Georgia Department of Public Health. The docu-drama has been field tested in several Georgia communities, and recommendations for revision of the script and modification of the device have been made to the Public Health Service before these educational aids are produced in quantity and distributed nation-wide.
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environmental health branch

HOUSING HYGIENE AND ACCIDENT PREVENTION SERVICE
Based on a year 1s study of housing problems related to health, the Accident Prevention Section submitted a reorganizational plan to include a housing program. Approved July 1, 1961, the Housing Hygiene and Accident Prevention Service was established to include two sections: Housing Hygiene Section and the existing Accident Prevention Section. Loss of personnel during the year curtailed the effectiveness of the various programs of the Service.
Accident Prevention Section - This Section concentrated its major efforts on the development of new materials based upon the requests, interest, and needs of local health departments. There was an increased interest in the areas of geriatrics, seat belts, poison prevention, and nursery school standards. Work with local health departments continued, but allied health groups were utilized to encourage more safety activities.
Progress in poison control, a major program of this Section, was marked by the establishment of two additional centers, one in the Macon Hospital emergency room, Macon, Georgia, and the other in Floyd
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Hospital emergency room, Rome, Georgia, bringing to ten the number of strategically located centers. All centers except one reported treatment cases and referred information to local health departments for follow-up.
To emphasize the problem of accidental poisonings, extensive community programs were sponsored by the Section during Poison
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Prevention Week through local health departments, Georgia Pharmaceutical Association, poison control centers and the medical societies of Georgia. Literature, news releases, radio and television spots and films were supplied with excellent response. A leaflet, "Wellbee's Pointers for Poison Prevention, " developed by the Section was well received by local health departments and given national mailing.
Monthly mailings were continued to new physicians with information concerning the operation of the Georgia poison control program.
Housing Hygiene Section - This Section's primary concern has been with the establishment of the administrative pattern including the necessary standards for conducting the program. The legal aspects, as they relate to housing hygiene and the regulatory provisions on both the State and local levels, have been tentatively defined through research with special reference given to the powers which are delegated to local Boards of Health for the adoption of regulations governing housing standards. These are being documented in a paper, "Legal Basis for Public Health in Housing, "with the aim of providing a procedure that may be followed by communities desiring to establish housing programs.
A pilot demonstration project was established under the auspices of a local health department. Field procedures, program aids and evaluation techniques are being tested through this project for practical applications.
The Section actively participated in the establishment of two local
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housing programs and the training of their personnel. A housing hygiene study committee, with representatives from six
local health departments was organized to advise this Section on the effectiveness of the procedures employed in the various localities.
Monthly reporting of housing activities was developed to provide a comprehensive report of health department activities in this field.
The Section qualified for the use of the American Public Health Association's Housing Appraisal Technique by satisfactory completion of the requirements as set forth by the Association.
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INDUSTRIAL HYGIENE SERVICE
The Industrial Hygiene Service is to discover, define, evaluate, and control those envirorunental factors in an industry which affect the health, well-being, and efficiency of the workers and to teach the workers to protect themselves from all known health hazards.
The Industrial Hygiene Service has a staff comprised of a service director, two engineers, three chemists, three radiation technicians, four electronic technicians, one health physicist on loan from the U. S. Public Health Service, two bedding inspectors and two stenographers. These professional personnel are grouped into four sections and one unit; namely the Industrial Section, Air Pollution Section, Radiological Health Section, Mattress Sanitation Section, and the Electronic Service Unit.
There are occasions when it is necessary to request the services of specialists from the Public Health Service and other allied Federal and State agencies. These services are available to us upon request, and with their assistance it is possible to evaluate most industrial health problems.
The increase in industrialization in the State has brought increased responsibilities to the Health Department. The local health department is the official agency specifically charged with the responsibility of assisting these establishments and their employees in all health matters. Assistance from the State Health Department is available to local industries only
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through their local health department. In carrying out the program for improvement of environmental
sanitation in industry, Industrial Hygiene personnel made investigations in approximately 247 establishments employing approximately 31, 211 workers in 75 counties during the period January l, 1961 to July 1, 1962. These investigations covered a wide variety of industries. During these investigations 197 samples were taken for laboratory analysis and 212 field determinations were made.
During 1961 the radiological health program was expanded to inelude milk sampling. Samples collected and analyzed by the Radiological Health Section included 402 air samples, 88 rain samples, 54 stream samples, 10 mud and silt samples, and 219 milk samples.
In the period covered by this report, the Electronics Unit made 50 major repairs to x-ray equipment and installed four other machines. The Unit also repaired 143 audiometers.
The state-wide air pollution survey was completed and the report of this survey published. Judging by the requests for copies, the report seems to be of considerable interest to the people of Georgia. Several preliminary studies have been done in the more populous areas of the State.
In 1954, the Industrial Hygiene Service assumed the responsibility for the enforcement of the Georgia Mattress Sanitary Regulations. During the period covered by this report 246 bedding inspections were carried out.
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PUBLIC HEALTH ENGINEERING SERVICE
The Public Health Engineering Service furnishes consultative, advisory, promotional and technical services; program planning and inservice guidance; plans and specifications review; record forms and materials; liaison with other state and federal agencies, architects, engineers, local government officials, and with other Health Department Services.
The second state-wide evaluation of enforcement of the Food Service Establishment Act of 1959 resulted in a score of 72. 32 indicating a general decline in sanitation compliance. Besides program status evaluation and organized group training, consultant services were rendered on many specialized problems such as mobile operations, floating food service operations, nursing homes, ventilation, vocational training, college food service operations, hospital dietary department sanitation, preconstruction plan reviews, hot water problems and dishmachines. More than 3400 contacts in 97 counties were made in the interest of food sanitation.
Seventy-two health departments, through local regulations, are engaged in milk sanitation activities. Twenty official sanitary surveys were made by Service representatives, and 31 spot checks of milk sheds were completed. Twenty-four sheds enjoy "Honor Roll" listings and it is estimated that greater than 90% of all fluid milk consumed in Georgia is produced on these sheds. More than 95% of milk consumed in the state is
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produced and processed under supervision of local health departments. It is significant that the percentage points of individual milk samples violating milk regulation requirements in coliform count (8. 84), standard plate count (6. 82) and phosphatase test (0. 20) are the lowest in nine years. Sediment testing (8. 72) has been added for the first time this year as routine procedure. One mobile milk laboratory has been in use in four sheds to assist with technical problems including control of psychrophillic, thermoduric and coliform organisms in milk.
The Service continues to review preliminary plans (228), working drawings and specifications (283) and final plans and specifications for final approval (248) of sanitation aspects to the Office of School Plant Services, State Department of Education.
One hundred ninety-five of 350 subdivisions, reviewed to determine adequacy of water and sewerage facilities, were new tracts. The remaining 155 were in the nature of follow-ups or additions to existing subdivisions. One community water system was given tentative approval. Central sewerage was provided in 14 subdivisions; six of the treatment facilities were "package" plants of the aerobic digestion type and eight were oxidation ponds.
Sewage disposal for 16 low-rent housing projects of the Public Housing Administration were reviewed. These, now in various stages of planning and construction provide for one oxidation pond, four small "package" plants, two covered sand filters and nine septic tanks with tile
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fields. Additional sewerage was reviewed for 13 commercial and industrial locations, two shopping centers, four convalescent homes, two boarding schools, four trailer parks, six recreational areas, one jail and one research laboratory. Individual sewage disposal systems numbering 1853 and water systems numbering 129 were reviewed for endorsement to the Federal Housing Administration and the Veterans Administration.
Tourist courts numbering 1270 were registered and permits issued to 1149. Permits were withheld on 42 pending completion of corrections, and no applications or inspections were received from local health departments on 79 courts registered in previous years. Sixty-three were reported closed and 16 remained in uncertain status.
Recreational area sanitation operations were stepped up coordinating the work closely with the State Parks Department in their expansion and improvement of sanitation facilities in Georgia State parks. Sanitation investigations were made at 57 marinas and camps of various descriptions located in 38 counties. Standards for public swimming pools proposed for adoption by the State Board of Health were completed.
Thirteen staff members of the Service participated in a 11crash" program during June in a sanitary survey of Lake Sidney Lanier, gathering information at homes within 500 feet of the government taking line, picnic areas, tent camp areas, clubs, marinas, garbage and refuse dumps, mosquito breeding, municipal and industrial wastes, swimming areas, island sanitation and food service establishments.
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The refuse collection and disposal consultant made 150 visits to 63 cities and 91 visits to 32 counties in the interest of sanitary refuse handling facilities.
Eleven shucker-packer oyster plants, two shell-stock dealers and one repacker were certified for interstate shipment of oysters. One plant was closed because of operations below standards. The State-PHSIndustry Cooperative Program is embarking on a new evaluation plan which is requiring closer cooperation between the State Game and Fish Commission and State Health agencies and increased sanitary surveys of areas adjoining shellfish growing areas.
hnpounded water permits were issued to 807 individuals and agencies. Four hundred and sixty permits were issued to farmers under the ASC farm practice program. Mosquito control programs are being continued on four Georgia Power Company lakes, one Crisp Power Commission lake, five U. S. Army Engineers lakes, and surveillance is practiced on three Tennessee Valley Authority lakes and on the U. S. Engineer Lake Sidney Lanier.
Training of sanitation personnel for local health departments has required approximately seven weeks participation by various members of the staff besides the full six-months time of the Branch Training Coordinator.
Preparing basic and sanitary survey maps, charts, forms, diagrams, floor plans, engineering drawings, exhibits, equipment, Ozalid
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prints, photographs, film, prints and slides (color and black and white), are major achievements of the Mapping, Cartographic and Photographic Unit. Charts for 13 major river basins in connection with the Federal Southeastern River Basins Study Commission were drawn. The Lake Lanier Sanitation Survey accomplishment would have been impossible without the rapid conversion of aerial photographs into mosaics and maps for the use of field parties engaged in this crash program.
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WATER RESOURCES SERVICE
The Water Resources Service was established July 1, 1961, for the purpose of expanding Departmental water resources programs, and bringing together several facets of the Department responsibility in water resources. This was necessary in order to meet the increasing emphasis that is being given to this broad program area. This Service incorporates the responsibilities and activities of the former Water Quality Service. Programs of this Service are: Water Supply; Stream Quality; and Water Analysis.
Water Supply - Plans and specifications were reviewed and approved for 38 additions and improvements to water supply facilities. Consuiting services were provided to municipalities and industries concerning water quantity, quality and treatment problems that are or may be encountered.
Stream Quality Sewerage Projects - Projects currently being carried out
by municipal and county governments have received a major part of the time and attention of the staff. Plans and specifications for 30 sewerage projects were reviewed and approved. Construction was completed on 18 new municipal sewage treatment plants. Federal funds in the amount of $1, 121, 500, for financial assistance under the Federal Water Pollution Control Act, Public Law 660, were allocated by the Georgia Department
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of Public Health. Industrial Waste Treatment - The increasing industrial ex-
pansion in the State has caused a greater emphasis to be placed on the necessity for proper waste disposal practices by industry. Four major industrial firms completed construction of facilities to provide waste treatment. As a result of stream surveys and investigations, 15 industrial firms were notified to abate stream pollution. The success of this program requires close cooperation between industrial interests and the State.
Stream Surveys - Several watersheds in the State were surveyed to determine possible sources and extent of pollution. A total of 166 sampling stations have been established on 18 streams. Major streams sampled were the Coosa River, Chattooga River, Oostanaula River, Etowah River, Withlacoochee River, and Long Cane Creek. Samples were collected to determine the physical, chemical, and bacteriological characteristics of the water. Significant data has been recorded on all of these watersheds and has already proved to be invaluable.
An inventory of public water supplies, industrial and municipal waste discharges into waters of the State has been completed by major river drainage areas. This inventory enumerates every major public water supply and source of polluting material, treated or untreated. Areas which require stream surveys or other work are thus delineated.
Water Analysis - In addition to making the water analyses necessary
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for the statewide water quality and stream quality programs, the Water Resources Laboratory is charged with the responsibility of the laboratory work connected with swimming pool and shellfish sanitation programs. The data and information derived from the tests were used by public health personnel, plant operators, municipalities, institutions, industries, consulting engineers, and private citizens in solving many of the problems in.herent in a statewide water resources program. No cases of water-borne diseases attributable to the approximately 650 community water supplies were reported during the year. Twenty eight thousand, nine hundred and thirty one of these were bacteriological tests and 6, 964 were biochemical, chemical and sanitary chemical analyses. A total of 35, 895 tests on water, sewage and industrial wastes were made in 1961-62.
Allied Activities - Conferences with adjacent states were held for the purpose of exchanging information, discussing interstate stream quality, and airing specific problems relating to stream quality. Public education and the promotion of water supply and waste treatment facilities received maximum attention.
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health conservation branch

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t'i CRIPPLED CHILDREN'S SERVICE
During the past year, clinic space and offices have been improved. The Elks of Georgia added an area to the building increasing the floor space by two-thirds. This contains separate offices for nurses and social workers and space for clerical staff. While in the planning stage several years ago, the space seemed more than ample. However, it is already out-grown. The Cardiovascular Disease Control Section installed a vectograph and a heart sound recorder and an up-to-date x-ray unit with closed circuit television was purchased.
The Macon City Hospital is allowing us to use a large room in the sub-basement for a clinic. This is by far the most adequate space we have had since we opened our clinic in Macon.
An x-ray machine has been installed in the Hall County Health Department. Prior to this installation the children had to be transported to a hospital for x-raying and the x-rays then brought back for reading.
The Chatham County Health Department provided adequate and functional offices and clinic space in their new building. We moved into the building during the winter.
The case load of seizure patients has grown so large that it seemed expedient to set up separate seizure clinics rather than seeing the children in the general clinic where a preponderance of orthopedic cases are handled. This is being done in Columbus, Macon, and Savannah. Others
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will be developed during the coming year. A pediatrician is chief of each clinic. Cases needing a more complete work-up than can be done in local clinics are referred to the central seizure clinic.
In February, a neurological seminar was held to acquaint the pediatricians with the latest methods in handling seizure patients.
The hearing program has been in operation since 1958 but not until this year has a well organized central hearing clinic been put into operation. Children are screened in the general clinic and if more definitive diagnostic workup is needed than can be obtained locally, they are referred to the central clinics. The team here is composed of a pediatrician, an otologist, an audiologist, a psychologist, a hearing technician, a social worker and a public health nurse supervisor. If a hearing aid is indicated, the patient is sent to the Atlanta Speech School for evaluation and fitting of the aid.
Participation continues in the research project on prostheses with the National Research Prosthetic Board. The Georgia program is one of 17 facilities in the United States participating in this program. Careful evaluation of the patient, correct fitting of the prosthesis and close follow up are components of this project.
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MATERNAL AND CHILD HEALTH SERVICE
Basic activities included medical and nursing supervision for mothers and children and promotion of hospitalization for delivery. In orientation of new nurses and in actual practice, special attention was given to health practices in day care centers, to the care of premature infants, and to infants and preschool children with special problems, such as mental retardation, maternal deprivation and auditory deficiencies. Family planning and classes for expectant parents were other basic elements of the program. Detection and increased frequency of hospital deliveries for prenatals with Rh sensitivity has been fruitful in reduced morbidity and mortality of the infants. Plans for a program for mass screening of the newborn for phenylketonuria have been completed.
New publications in use include "Common Problems of Early Childhood", "Desirable Standards for Day Care Centers", "So Your Child is Going to a Day Care Center", "Georgia Mother and Baby Book" (revised), "Care of Premature Infants in the Horne - Guide for Public Health Nurses", and the manual for teaching midwives.
Vital Statistics - Although the premature birth rate rose significantly, the death rate decreased to an extremely favorable low. The infant mortality rate also decreased in the neonatal and post-neonatal period. The maternal death rate increased due to a rise in the white race.
In 1961 there were 100, 444 births of which 9, 359 occurred in the
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home, and were delivered by midwives. Clinics - One hundred nine counties have maternal clinics with phy-
sicians 1 services, and 100 counties have well child conferences with physician participation. Seventeen counties have nursing conferences for mothers and children.
In 1961, 26, 296 expectant mothers received public health nurse supervision, and 16, 708 were registered in the clinic for medical supervision. These women averaged three and a half visits to the physician.
In the same year, 43, 110 infants were given nursing supervision, and 17, 325 received medical health guidance. However, these averaged less than two and a half visits for medical supervision.
In 1961, 60, 537 preschool children, ages one through five, were registered for public health nursing supervision, and 21, 553 for medical health supervision. They averaged one and a half visits for medical supervision.
Immunizations - Nearly 90, 000 immunizations against diphtheria, tetanus and whooping cough were completed during infancy and through the first five years of life. About 63, 000 in this age group received Salk vaccine, 19, 321 during the first year of life.
Special Project in Mental Retardation - The Child Development and Evaluation Center, designed to serve 12 counties as a demonstration of what can be done to diagnose and evaluate preschool children with limited intellect, and what can be done to assist the families in the home care and
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training of these children continues, despite staff limitations. There is an increasing proportion of referrals from private physicians. There have been six formal public health nurse training programs this last year. Student nurses at the local hospital have also profited from teaching experiences with the project staff.
The Interagency Committee on Prematurity - This committee has been active in all phases of prematurity, including family planning, prenatal care, hospital-home care and follow-up, and planning for one or more institutes for institutional nurses. Twenty per cent of the premature births reported in the State occur at Grady Hospital, where seven per cent of the live births occur. Prematurity contributes heavily to the case load of mental retardates and multi-handicapped children.
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NUTRITION SERVICE
The Nutrition Service has worked on the development of a training plan which will encourage recruitment and retention of young graduates to fill vacancies in regional and state positions. This plan received high priority and the Service cooperated with the Personnel Service to formulate a series of job descriptions to implement the plan. The state institutions and the Service met to begin joint planning to solve their mutual problems.
Two additional persons joined the staff, a medical director and a junior nutritionist. The dietary consultant returned from educational leave.
The public health activities of the Service include the following: Schools - Educational activities included rat experiments, films, talks to children, parents and other civic groups, dietary evaluations, and teaching mother-baby care classes in high schools. Education - The health officers and the director met to plan the nutrition guide which the health officers requested, A committee was appointed to determine the needs which the guide will meet. Group education and training was given to district nursing staffs, nursing classes 1n hospitals, college groups, practical nurses, aides and social workers, nursing home personnel, pre-school associations, Food Service Institutes and Institutes for Blind Homemakers. Patients and Clinics - Consultation with parents of over 700
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crippled and cardiac children in seventy-odd clinics was the single largest activity of the Service. The nutritionists counseled 256 prenatals and 55 mothers of infants in MCH clinics. One member taught four classes of unwed mothers at the Florence Crittenton Home. Other assistance included special classes for diabetics to aid them in solving their dietary problems, individual consultations with the obese, the chronically ill and the older citizen, work with those receiving surplus commodities and low income families.
Interagency Cooperation - Nutritionists worked with visiting nurses, the Alcoholic Rehabilitation Center, hospitals, and the Welfare and Education departments. Nutritionists also participated in training courses for day care personnel conducted by the University of Georgia.
Materials and Publicity - The Service distributed educational rnaterials, wrote articles for publications of various sorts, made television and radio appearances, and talked to civic groups.
In-Service Education - Two members went to the Community Nutrition Institute at Syracuse University, and two to the Institute on Nutrition on Chronic Diseases and Aging at Chapel Hill. Several individuals served on the Geriatric Task Force and one participated in the Home Care Project at Dalton. The dietary consultant returned after securing a Master's degree in Public Health from California.
Future Objectives - To organize a Community Nutrition Program which will care for all segments of the population, and to secure training facilities which will supply personnel necessary to carry out programs.
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SCHOOL HEALTH SERVICE
Hearing Conservation Program - The program continues to serve about the same number of children, but since services to children with hearing losses have become available through Crippled Children's Service, there is more genuine interest in medical and rehabilitative follow-up. For the school year 1961-62, 92 counties reported that 110,449 children were tested, 6, 103 failed the tests, and 2, 400 were seen by the doctor.
In an effort to refine the case load of the public health nurse and to eliminate unnecessary and costly over-referrals, hearing screening clinics manned by an otologist were held in four counties. The otologist rapidly examined 268 children for the purpose of medical and etiologic~! diagnoses. The Service provided staff to Maternal and Child Health Service to help develop a program for testing the hearing of infants, using Ewing techniques as practiced at Johns Hopkins.
Vision Conservation Program - In the school year 1961-62, 93 counties reported 285,998 children were tested, 21,019 failed the tests, and 10, 833 were seen by the doctor. A study of our records shows that only a small percentage of Negro children ever reach diagnostic and treatment sources. In addition to children in regular schools, the Service helped in vision testing children at the Georgia School for the Deaf at Cave Spring.
Ringworm of the Scalp - In several counties, the Service worked
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with Communicable Disease Control and local health and education departments to do a detection study and treatment program in schools where this disease had become prevalent.
Detection of emotionally disturbed children - A questionnaire for teachers to use as a tool in detection of emotionally disturbed children is being field tested in one school. This study is being done in conjunction with state and national mental health services.
With the cooperation of the Health Education Service, the staff revised and published a manual on hearing testing and a flip chart on control of communicable diseases in children.
In-service education - One staff member attended an Institute on Infant Audiologic Screening at Johns Hopkins; all of the staff participated in a similar session in Atlanta. All staff members attended a course on audiometry at the University of Georgia, sponsored by Crippled Children's Service. The director attended an Institute on Alcohol Education at Millsaps College in Mississippi.
Out-of-state meetings - The director attended a meeting on Health Education Curriculum in Colleges and Universities, at the University of Florida; a three day meeting on safety, sponsored by Florida Health Department, U. S. Public Health Service, and National Safety Council, in Jacksonville; and the American Speech and Hearing Association meeting in Chicago.
The Service worked closely with the State Department of Education
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in many areas, including classes in health education for teachers in colleges and universities. The director participated in numerous conferences with agencies offering services to children, such as the National Society for Prevention of Blindness, the Georgia Heart Association, the Georgia Tuberculosis Association, the Parent-Teacher Association, and others; and served on various committees, such as the Committee for Children and Youth, Committee for Study of Diagnostic Centers for Multihandicapped Children, School Child Health Committee of the Medical Association of Georgia, and the hearing advisory committees of the State Departments of Health and Education.
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laboratory branch

LABORATORY SERVICES
In addition to the testing service for the investigation and diagnosis of communicable and other diseases of public health significance and the examination of milk and dairy products to determine sanitary quality, auxiliary services were carried on. These included referral services in the critical identification of disease-producing organisms isolated in the Department and other laboratories in the State; the evaluation and approval programs to laboratories under the State premarital and prenatal laws; the milk certification program; preparation of typhoid vaccine and other biologics for the prevention of disease; the preparation of specimen outfits and the procurement and distribution of commercial antirabies vaccine.
A closer working relationship was developed during the year with the Department 1s institutional laboratories and the local health department laboratories. Reviews of laboratory programs in the Gracewood and Aidmore institutions were made by our Director of Field Laboratory Services at the invitation of the superintendents. Initial steps were taken in the development of a standard laboratory report form and monthly and annual report forms for the institutional laboratories. Similar efforts will be made with the local health department laboratories.
During the fiscal year there were 950, 368 examinations made in the four laboratories. This was a slight increase over the preceding fiscal year. Increases were noted in all laboratories, and in the
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Microscopy, Serology and Virology Sections. Of especial interest was the lOOo/o increase in examinations made in the Virology Section.
Unusual and noteworthy findings in the diagnostic work included: - seventy isolations of Salmonella typhi obtained from 29 cases of typhoid fever. Forty-five isolations made from 15 chronic typhoid carriers. Two new carriers were identified. Three cases were traced to three known carriers based upon epidemiologic data and phage types. - an unusual salmonella episode was the finding of S. tennessee in an outbreak associated with dyed "Easter chicks." Positive stool cultures were obtained from five children and two adults. Pet chicks from three homes yielded S. tennessee. -food samples and/ or patient specimens were examined in connection with 23 outbreaks of food poisoning (Central Laboratory, 17; Macon Laboratory, six). Causative agents isolated included coagulase positive staphylococci in four outbreaks and Shigella flexneri-6 in one. - a worm removed from a patient's mouth was identified as Gongylonema pulchrum (gullet worm). Only a few cases have been reported in the United States. One hundred and three laboratories participated in our evaluation program for laboratories performing serology tests for syphilis, including six State laboratories, 94 private laboratories and three others. Six of the private laboratories did not complete the study and two private laboratories were removed from the approved list.
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Although the incidence of rabies remains at an all time low, 1, 212 animal heads were examined during the year. Ten showed positive evidence of rabies, an increase of four over the preceding year. The low incidence was also reflected in the distribution of commercial antirabies vaccine. Only 85 treatments (32-seven-dose and 53 14-dose) were furnished. Veterinarians and veterinary helpers received either threedose pre-exposure immunization (41) or one or two booster doses (36).
During the year a number of special projects were undertaken, most of these being in cooperation with other Department branches and services.
- the Virology Section and Special Syphilis Serology Unit participated in the evaluation of a new complement-fixation procedure being developed by the Communicable Disease Center. The test is called LBCF (Laboratory Branch Complement Fixation).
- cat-scratch fever skin testing antigen was obtained and provided to eight physicians on special request. Case histories, suppurative material (when available), and skin test results were obtained and forwarded to the supplier of the antigen. Supplementary tests included LGV -CF on patients 1 serum, 0. T., and PPD-Y skin tests, and bacteriological and virological studies on suppurative material when available.
- a review of the sandwich study was made in cooperation with the Epidemiologic Investigation Branch and the study was expanded to include examination for pathogens (staphylococci and salmonella), total bac-
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terial and coliform counts, and determination of pH. There were 820 sandwich samples examined.
- early in the fall of 1961, the Central Laboratory assisted the Epidemiologic Investigation Branch in determing the cause of a shrimpkill in the Brunswick area. Bacteriological examinations resulted in the isolation and identification of Pseudomonas ichthyodermis, shown to be associated with "brown spot" disease of shrimp.
- a laboratory representative attended a special training program at Children's Hospital, Buffalo, New York, in preparation for our participation with Maternal and Child Health Service in a national program sponsored by the Children's Bureau of the Public Health Service in the detection of phenylketonuria (PKU) in the newborn.
- the Virology Section cooperated with Epidemiologic Investigation Branch in a study of viral hepatitis. Paired blood specimens (391) from Gracewood State School and Hospital were shipped to Doctor Albert McKee, State University of Iowa for testing with his viral agent by means of the hemagglutination-inhibition and mouse neutralization tests.
- poliovirus survey - an investigation of enterovirus prevalence among healthy young children, age 18 months to four years, from six housing developments in Augusta, Columbus, Macon, and Savannah resulted in the isolation of 98 enteroviruses from 461 stool specimens examined. Poliovirus 1 was obtained from two Savannah children and poliovirus three from one Augusta and one Columbus child. Viruses
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isolated from 45% of the Augusta specimens showed that Coxsackie B3 viruses were abundantly present in this area at the time of the study. All other enterovirus isolates are being used for testing new methods of identification.
- a preliminary study was started (49 specimens in fiscal 1962) in cooperation with Cardiovascular Disease Control Service to evaluate the possible significance of recent reports that rheumatic fever patients on penicillin prophylaxis develop penicillin resistant strains of oral bacteria (especially alpha streptococcus) which, upon subsequent dental manipulations, enter the blood stream and produce subacute bacterial endocarditis. Control studies were made on patients on sulfadiazine prophylactic programs.
-- the Central Laboratory participated in the Atlanta Metropolitan Area Sabin oral polio vaccine immunization program to the extent of assisting in the procurement, storage, and distribution of the vaccine.
On June 1, 1962, differential blood counts were discontinued. In September, 1961, the refractometer test for added water in milk was discontinued and a more accurate and efficient method utilizing the cryoscope for determing the freezing point was substituted.
On July 1, 1962, the Media and Reagents Section was combined with the Sterilization and Glassware Preparation Section and given the name of Preparation Section. Early in 1962, Cardiovascular Disease Control Service was authorized to temporarily utilize three and a half
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rooms on the seventh floor animal quarters area for the development of a lipid research laboratory.
In addition to the overall training program routinely conducted for new untrained technical personnel, an experimental program of rotation was instituted on April l, 1962 and participated in by our eleven medical laboratory assistants. Basically the program involved staggered rotation on a three months basis among the six sections in the Central Laboratory.
During the year nine staff members attended a total of 12 courses offered at the Communicable Disease Center of the U. S. Public Health Service in Atlanta. One staff member attended two courses given at the Sanitary Engineering Center of the U. S. Public Health Service at Cincinnati, Ohio.
Two conferences and a seminar were held in the Central Laboratory. These were attended by Central Laboratory section chiefs and Regional Laboratory directors, the Department's institutional laboratory directors and local health department laboratory representatives. These were primarily for the purpose of reviewing programs, activities and new procedures. During the first conference held November l-2, 1961, the present status of fluorescent antibody techniques was reviewed and studied. Highlighting the second conference held April 11-12-13, 1962 was a visit to the Battey State Hospital Laboratory. A seminar on atypical mycobacteria organized in cooperation with the Epidemiologic Investigation Branch was held on January 20, 1962.
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local health branch

LOCAL HEALTH ADMINISTRATION SERVICE
Considerable time and effort was expended in working with those persons responsible for drawing up a proposed revision of Public Health Laws. Despite the time and effort spent on this activity, the final bill presented to the State Legislature died in committee.
Long range planning had been done to secure personnel to staff a local health evaluation team. However, efforts failed to recruit qualified personnel for the team. The physician selected to head the evaluation team was diverted into the position of Director of the Northern Health Region upon the retirement of Dr. J. Russell Thomas.
Operations in local health districts were hampered by the untimely passing of Dr. Eustace H. Prescott, District Director of Public Health District 24, and Dr. James A. Thrash, District Director of Public Health District 35.
We were able to recruit and place in active service, a District Director of Public Health in District 6 and a District Director of Public Health in District 27. At the close of the year, the number of health districts with District Directors of Public Health remained the same as of the close of the previous fiscal year, namely 24.
Through continuing efforts of our regional staff, we were able to make preparations for reactivation of the Wheeler County Health Department, Stewart County Health Department, and the establishment
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of a health department in Heard County for the first time. all on July l. 1962.
During the year. there was a net increase in local health department personnel which included 19 nurses. 11 sanitarians. seven clerical workers and 15 other full-time local health personnel.
Construction was completed on three health centers and three auxiliary health centers. At the close of the year. two health centers and two auxiliary health centers were under construction. and architectural plans were under way on four additional auxiliary health centers.
The operations of Local Health Administration were considerably hampered by the resignation and untimely death of Mrs. Emily W. Bartholomai. who had served in the position of Public Health Administrator with the Service.
We recruited a qualified administrator on July 1. 1962. increasing the effectiveness of our operations.
Considerable effort on the part of the Service was put forth in the survey of Lake Lanier and surrounding areas. This survey called for the use of Northern Region and Central Office personnel of Local Health Administration Service during the month of June. with the field work being completed on the last day of June.
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PUBLIC HEALTH NURSING SERVICE
The director of Public Health Nursing Service retired December 1961. Public Health Nursing was reorganized January 1, 1962. The position of Coordinator of Nursing Services was established in Local Health Branch.
Six hundred and ten public health nurses were employed in counties, regions, and the State Health Department as of June 30, 1962. Ten counties did not have public health nursing service. During this 12 month period, there were 73 appointments, 46 resignations, and four retirements.
Thirty-nine nurses had orientation in public health nursing; 50 had orientation at Milledgeville State Hospital; and 79 had orientation at Battey State Hospital. Local health departments in Georgia provided field experience for 60 basic collegiate students and graduate nurse students from the following schools: Peabody College (three), Emory University (36) basic and (four) Master's degree, and Tuskegee Institute, Alabama (17). The Medical College of Georgia used Chatham County facilities for field experience.
Other educational activities included academic preparation in public health and allied fields; short courses and seminars in audio-visual aids, epidemiology, physical rehabilitation, stroke rehabilitation, chronic disease and aging, alcohol studies, psychiatric nursing, venereal disease
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control, tuberculosis control, medical self-help, training methods in communicable diseases, mental retardation, special fields in public health nursing, leadership training, principles of supervision, hearing testing of infants and preschool children, field training conference, and instructor course for mother and baby care classes.
Visits were made to regional offices and county health departments to develop an additional field experience center. Staff members offered other consultation services including: assisting with evaluation of nursing services and of students during their orientation; participating in in-service education programs; preparing instructors in mother and baby care classes; counseling staff and supervisory nurses regarding experience or education needed for promotion; and assisting with nursing activities including personal and professional problems.
A new field training center was opened in District 27, which included Walker, Catoosa, Chattooga, and Dade counties.
The expansion of programs for the care of the chronically ill and aged require additional nursing personnel. Licensed practical nurses worked in a horne care program in Whitfield County. Progress has been made in the development of policies and procedures for the employment of practical nurses. The Annual Supervisors 1 Conference was devoted to the use of practical nurses in public health programs.
Group activities included participation in the Departmental Advisory Council; State Health-Education Committee; Georgia Council on Para-
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medical Education; Training, Epidemiology, Inter-Agency Premature, Library and Publications Committee; Geriatrics Task Force; and Georgia Organization Nursing Committee on Respiratory Diseases Including Tuberculosis. Assistance was given in developing curricula for training directors of day care centers.
The Maternal and Child Health Section of the General Nursing Manual was revised and made available to public health nurses throughout the state.
Recruitment of nurses was fostered through contacts with students and instructors in schools of nursing, public school counselors and others. Opportunities for employment and functions in the field of public health nursing were interpreted.
Staff members were active in local, state and national professional organizations. Considerable work was done through other state and voluntary agencies including the Georgia Heart Association, Mental Health Association, Atlanta Social Workers' Club, Georgia Public Health Association, Georgia Tuberculosis Association, Red Cross and the Atlanta Visiting Nurse Association.
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NORTHERN HEALTH REGION
A total of nine out of thirteen planned districts were functioning, each with a district director of public health, as activated districts in the Region. Concentrated efforts were being exerted toward activation of District #25 and realization of its activation is almost a certainty within a period of six months. Six of the activated districts have a district director of nurses and seven have a district director of environmental sanitation.
The Region is composed of 51 counties. Twenty-eight of these are included in activated districts; 20 are in unactivated districts; and three, Pickens, Towns and Union have no organized local health departments. Pickens County is showing more than average interest and may soon join the ranks of full-time health services.
The Northern Region staff consists of: two nurse consultants, two nutrition consultants, two engineers, two sanitarians, two stenographers, and one medical director.
A total of 15 physicians, 215. 6 nurses, 114 sanitarians and engineers, 112. 6 clerical people and 121 other employees were on duty in activated districts as of December 31, 1961. Thirty-two nurses, nine sanitarians and 23 clerks were employed in the unactivated districts. There continues to be a shortage of qualified public health personnel. Two counties are without public health nurses and nine counties are without sanitarians.
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The status of construction of new health centers is as follows: Gordon, Cobb, and Rockdale counties each completed a health center under the Hill Burton construction program; an auxiliary health center was completed in DeKalb County. White, Wilkes and DeKalb counties submitted applications for construction of health centers.
A total of 2, 639 visits by Regional personnel were made to local health departments. These visits may be classified as follows: Physician 99, Nurse - 328, Engineer and Sanitarian - 721, Nutritionist - 180, Communicable Disease Investigator - 1, 289, and Clerk - 14. These visits were made to provide assistance and consultation to district directors of Public Health, Nursing, and Environmental Sanitation in their health programs, and for the performance of direct service.
Regional engineering and sanitation consultants furnished direct service to the counties without engineering and sanitation personnel; a minimum of direct service was provided to counties without nursing personnel by the nurse consultants. The medical director served as acting public health officer for 17 counties having no local medical supervision except from the physician member of the County Board of Health.
The supervision and licensure of nursing homes became an increasing activity. The Region assumed this responsibility for 12 nursing homes located in areas with no district director of public health or without sanitation personnel.
Four in-service training conferences were held for local health de-
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partment personnel. One of the two regional nutrition consultants attended an institute on Nutrition in Chronic Disease and Aging at the University of North Carolina.
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CENTRAL HEALTH REGION
During the period covered by this report, the region was fortunate to have a medical director. Staff complement during this period was reduced by the death of one consultant nurse and the retirement of another. These vacancies have since been filled.
Two new projects which have been added are: a study of blood pressures in Baldwin County and expanded services to the 19 counties being served by Diagnostic and Evaluation Clinics in the Tuberculosis Service. Oral polio vaccine was distributed on a county-wide basis in Clayton County.
Consultant nurses attended institutes on mental health (including intensive treatment), hearing conservation, and orientation for public health nurses. In-service training for local public health nurses included disaster nursing in civil defense, maternal and child care, family planning, care of stroke patients and a review of mental health services. New concepts in tuberculosis service were also presented.
The work load (direct services) of the regional sanitation staff continues to increase because of transfers, resignations, and failure of the counties to employ sanitarians. Limited supervision continues in the counties with sanitation personnel. Past and current promotional work by the staff for municipal sewerage systems is beginning to show results in Crawford, Fayette, and Heard Counties. Towns in these counties have
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employed engineering firms to draw up plans for sewerage systems. Water and sewer extensions in the majority of counties are increasing at a rapid rate.
Venereal disease within the Central Region is still increasing. Four areas within the region have had early infectious syphilis epidemics. Health investigators at Macon, Augusta, Columbus, Savannah, and Atlanta are working to control these epidemics.
The increase in venereal disease seems to be caused by the lack of knowledge or concern by the teen agers or their parents; the homosexual problem; and the general public 1s unawareness of the situation.
Due to the lack of nutrition personnel on the regional staff, services of this nature were limited during the period covered by this report.
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SOUTHERN HEALTH REGION
The region is composed of 57 counties in South Georgia with an area of 24, 000 square miles (41% of State) and a population of 977, 000. There are 592 private physicians, 213 dentists, 57 hospitals with 3, 245 beds, 22 nursing homes in 13 counties - 999 beds. Six counties have no physician, 18 have no dentist, 16 have no hospital.
Eleven of our 13 districts are operating under district directors. Six districts have directors of nursing and nine have directors of environmental sanitation. All 44 counties have public health nurses but only 37 have a local sanitarian. In the other 13 counties, which are not in an organized district, 11 have a nurse but only four have a sanitarian.
Regional public health personnel include: one public health engineer-administrator, one sanitarian-administrative aid, three nurse consultants, two sanitarians, one dental consultant, one nutritionist, six health investigators (V. D.), one medical entomologist, two clerical field representatives, and six stenographers.
There is a growing demand upon the regional office for assistance. Staff members made 3, 000 visits to the counties during the year. A continuous health education and promotional campaign was carried out to establish and expand local health facilities. Four new Hill-Burton centers were completed, three are under construction, four counties have submitted informal applications for financial aide. A local nurse was re-
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cruited for training and will open a health department in Stewart County in late 1962, for the first time since 1944. Schley County officials agreed to let the citizens vote in September, 1962 whether to have a health department. A clerk was employed in Clay County for the first time. Wheeler County has reopened its health department with a complete staff.
The two Albany regional nurse consultants completed a three weeks concentrated course in Supervision and Interpersonal Relationships. Two three day seminars on the care of the stroke patient were well attended. The Tuberculosis Diagnosis and Evaluation Clinic is of great value to the eight counties served. A mental health clinic was established in Dougherty County on an out-patient basis. Nursing activities from the Waycross office were reduced due to illness and resignation of the nurse.
Dental clinics were opened in three counties and equipment is on hand for two others. Interest in fluoridating public water supplies was promoted throughout the region. A pilot Surpak Radiation Survey of private and institutional dental offices in the region was made.
The nutritionist worked with Crippled Children s and Maternal and Child Health clinics, did hemoglobin tests and three day diet histories in several schools, and gave numerous talks on nutrition.
All of the 12 milk sheds have a sanitation compliance of above 90%. Food sanitation has made progress against stubborn resistance due to financial problems, usually involving tenant-landlord situations in small volume establishments. District #14 made better than 90% compliance
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with the food sanitation regulation. The regional engineer and sanitarians have assisted local health personnel and local officials and individuals in 16 non-sanitarian counties with surveys and evaluations of all local sanitation situations.
There were 6, 643 venereal disease investigations which found and brought to treatment 151 new cases of primary and secondary syphilis, 53 cases of early latent syphilis, 115 cases of other syphilis and 283 cases of gonorrhea. Since January 1, 1962 there has been a steady decline in syphilis in the Albany region, while an increase is now indicated in the Waycross region. Four new health investigators have been trained at the Albany office, two being transferred later.
The medical entomologist has been associated with the research program on the viral encephalitides and vesicular stomatitis in the Waycross area, and assisted with fly and mosquito problems region-wide.
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preventable diseases branch

CANCER CONTROL SECTION
The cost of the state-aid program increased sharply during the year due to an increase in the rates paid for hospital care.
Prior to fiscal 1962, this program paid for hospitalization at 7 So/o of the average per diem cost. Since July 1, 1961, however, payment has been made at 100% of cost.
Since the budget for fiscal 1962 remained unchanged, the increased cost of hospital care made it necessary to interrupt the program temporarily in February, 1962 in so far as new patients were concerned. Mter an interval of three weeks, additional funds were made available and the program resumed operation.
The original budget for fiscal 1962 was $400, 000. 00. When the hospital rates were adjusted as of July l, 1961, it was estimated that the new rates would result in an increase in the cost of the program amounting to $135, 000. 00 annually provided the case load remained at the same level as in recent years. However, during the first six months of 1961, the number of applicants for state-aid had materially increased and it appeared that this would provide an additional financial burden. As the year progressed the number of applications declined. Moreover, during a period of three weeks in February and March, 1962, no new applications were approved. As a result, the accrued cost of the program for fiscal 1962 amounted to only a little more than $500, 000. 00.
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During the year, 2470 persons submitted applications for stateaid. This represents a sizable reduction in the number of applicants as compared with previous years when the annual figure was about 3000. This decline in the number of applicants may be accounted for, in part, by the fact that no applications were approved during a three week period beginning in February. However, following resumption of the program, the number of applicants per month remained well below the average figure observed in recent years.
Including patients from previous years who returned for additional treatment, a total of 4179 persons received diagnostic or treatment services.
In order to limit expenditures and keep the program operating without interruption through fiscal 1963, it was considered desirable to review the existing rules and regulations and make such modifications as might be indicated. A committee of three physicians assisted the Director in preparing a supplementary list of regulations. Subsequently, these were approved by the State Board of Health.
With the hospital rates which are currently in effect, hospital care accounts for 85o/o of the total cost of the program. In recommending changes in the existing regulations, therefore, most emphasis was directed toward reducing the number of hospital days.
The supplementary regulations do not differ in principle from those which have been in effect since the program was initiated. In certain
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areas the new regulations are more explicit in outlining the circumstances under which patients may be admitted to the hospital and, also, in placing restrictions on the duration of the hospital stay.
All of the approved cancer clinics continued operation throughout the year. There were no new clinics which met the minimum requirements for approval.
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CARDIOVASCULAR DISEASE CONTROL SERVICE
The Cardiovascular Disease Control Service cooperates closely with the Georgia Heart Association and the Heart Disease Control Program, U. S. Public Health Service and other private and public agencies to develop research and service programs designed to detect, correct and prevent heart disease.
Twenty-four professional and non-professional personnel are presently engaged in the various programs being conducted by this Service in Georgia.
Current Programs - Operating programs include hypertension, congenital heart disease, rheumatic heart disease, stroke rehabilitation, congestive heart failure, atherosclerosis and heart clinics.
Hypertension - A county wide survey is under way in Baldwin County to determine the nature, level and extent of hypertension in a community and see if applied control measures might reduce the level. Another feature of this program is the enlistment of each heart clinic to provide standardized workups on indigent hypertensives to provide a baseline group for statistical and therapeutic studies. One of the highlights of the year was a cooperative project with the U. S. Public Health Service, Georgia Heart Association and several local hospitals in presenting a hypertension seminar with internationally known authorities serving as the faculty.
Atherosclerosis - The monk study has recently been approved for
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another five years. This study, comparing two different monastic orders, is attempting to determine the role of diet and other factors in atherosclerosis. The cardiovascular laboratory set up for this project has now been transferred to health department facilities and serves the needs of the entire Service.
Congenital Heart Disease - This program continues to cooperate with the Crippled Children's Service in providing personnel and equipment for diagnosis, treatment and care of afflicted children, through clinics, laboratories and hospitals. A plan has been formulated to evaluate the usage of heart sound tape recorders as a casefinding technique.
Rhewnatic Heart Disease - This Service continues to provide medication to private physicians and heart clinics as prophylaxis for approximately 1, 200 indigent patients against the recurrence of rheumatic fever, together with furnishing facilities for acute and chronically ill patients. A study of bacterial flora in the mouths of patients on sulfa and penicillin prophylaxis is being made to determine whether or not resistant bacterial strains have developed.
Stroke Rehabilitation - The "Stroke Team" consisting of one physician, a consultant nurse and two physical therapists has broadened the scope of this program to cover the entire state. Through teaching seminars for public health nurses, nursing home personnel, etc., there is now a vast reservoir of trained personnel capable and ready to assist the stroke patient and his family in simple rehabilitative technics. Consul-
- 62 -

tations on problems or unusual cases are available upon request. A meeting of physical therapists will be held in Atlanta in cooperation with the Public Health Service to discuss the future role and relationships of physical therapists in community and hospital centered rehabilitation programs.
Congestive Heart Diseases - Programs to maintain treatment regimens of digitalis, digoxin, etc., are supported through the heart clinics.
Heart Clinics - There are sixteen heart clinics, including the Crippled Children's Clinic in Atlanta, now functioning to provide diagnostic evaluation, advanced corrective surgery and all types of care and medication for heart disease patients. Regular clinic tours are conducted with the Georgia Heart Association staff to discuss local problems and seek solutions that will enable the clinics to function more efficiently and better serve the populations. We are now contracting for payment of x-rays on out-of-county patients to alleviate what has been a major problem in these clinics.
Other Aspects -the Directory of Cardiac Services has been revised and distributed to every physician, health department, clinic, etc. , throughout the State. - we are continuing to supply the Heart Bulletin to physicians and medical students in the state as an educational tool.
- 63 -

- this Service has formed a "journal club 11 which meets one night each month to review current heart literature and discuss latest developments in order to keep abreast of modern research and scientific trends.
Plans - The future direction and emphasis of this Service is to concentrate our efforts towards extending our services more effectively at the local level.
- 64 -

EPIDEMIOLOGY SERVICE
The basic function of the Epidemiology Service is to act as a clearing house for information relating to the prevalence and incidence of infectious and non-infectious diseases and other causes of morbidity. The problem is one of careful classification and careful quantitation and has been approached in the following ways:
-morbidity reporting systems of two kinds: (l) a standard morbidity card method for reporting by physicians to county health departments and (2) a sampling system designed as a measure of the effectiveness of reporting.
- surveillance and confirmation of diseases on which laboratory work is done. The oldest surveillance system, that for Rocky Mountain spotted fever, is now in its 31st year. The newest, for Salmonellosis, is in its first year.
- surveys of absenteeism from school to determine the prevalence of epidemic disease, such as influenza.
- intensive field studies to determine the actual extent of a diseas~t in a group or the health status of a group. In 1961, one such continuing study further explored the possibility that food poisonings referable to the consumption of commercially prepared, wrapped sandwiches were being over -looked. A direct request was made to physicians for telephonic reporting of all cases of food poisoning in which sandwiches might be suspected. No illness was discovered.
- 65 -

- research studies intended to reveal the nature, fundamental

characteristics, and sources of various diseases. Six major research

investigations are in progress.

These research studies include the following:

- a study of certain consistently present virus infections

of animals which have been found to infect man with or without recognized

disease. In 1961, EEV was abundant in certain mosquitoes.

- a study of the ecologic and chemical factors producing a

slime growth nuisance on a major Georgia river. As a means of avoiding

this problem a study is underway to determine the practicability of disposal

by overhead irrigation of a planted acreage.

- a study of the basic bacteriology and ecology of the

bread-filler-cellophane wrapper system formed by a wrapped sandwich.

Bacteria in this complex appear to be adversely influenced by low pH (or

acetic acid ions) and in all probability by other factors.

- a carefully controlled study of the immunogenic proper-

ties, both serologic and epidemiologic, of various staphylococcus toxoid

preparations with and without added bacterial protein in the prevention of

institutional problems caused by "epidemic" strains of staphylococcus.

- a study of the effectiveness of certain prophylactic drugs

in controlling endemic diarrheal infections in institutions for children.

- a study of the effectiveness of immune serum globulin

when used as an eye instillation in the prevention of infectious hepatitis in

institutional populations.

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- longitudinal studies intended to work out through systematic, continued observations pertinent facts concerning chronic and degenerative disease. One continuing investigation involves the examination by extremely sensitive serologic screening tests of the sera of retarded children for evidence of infection with animal viruses, e. g., EMC, and an attempt to relate the findings to the patient's history. Exploratory field work was undertaken on mouse polyoma virus as an exercise in viral ecology.
(See reports of the Laboratory, Vital Records, Venereal Disease Control and Tuberculosis Control Services for data in addition to that contained in the attached table. )
- 67 -

Summary of Reported Communicable Diseases 1961 (With Comparisons with Earlier Trends)

This represents the work of several divisions, particularly Epidemiology and Biostatistics.

Median 1950-54

Amebiasis Brucellosis Chickenpox C onjunctiviti s, infectious Diphtheria Encephalitis, unspec. Hookworm Infectious Hepatitis Influenza Measles, German Measles, Red Meningitis, unspec. Meningococcal infections Poliomyelitis Psittacosis Rheumatic Fever Rocky Mt. spotted fever Salmonellosis Shigellosis Streptococcal infections Tetanus Trichinosis Tuberculosis Tularemia Typhoid fever Typhus fever Whooping cough

21 64 NR NR 220 15 15, 491 703 6, 058 NR 6, 743 NR 93 505
1 79 13 95 321 842 33
0 2, 085
44 64 41 398

Median 1956-60

Regular Reporting
1961

12 25 NR NR 101 17 9, 037 149 1, 621 NR 4, 854 93 38 93
3
49 21 280 325 3, 663 23
1 1, 576
22 31
8 135

4 14
6 1 64 17 6, 680 771 108 34 496 94 23 26 2 14 6 321 502 204 33 1 1, 627 15 34 8 12

Sampling 1961
200 30
1, 010 6, 740
90 80
5, 100 31, 660
4, 060 19, 140
70 140
60 20 1, 080 100 520 490 70, 090 80 170 240 20 40
610

Cases Reported by Sampling Only 1961

Leptospirosis Staphylococcus
Pulmonary Superficial Wound

40
680 8, 980 3, 020
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GEORGIA STATE EMPLOYEES HEALTH SERVICE
This Service has been in operation since late 19 56. Each year the mmber of employees taking advantage of the services offered has increased. fhis has meant adding personnel as a result of the increased workload.
The major objective of the program is to enable employees to )etter serve the State. This is accomplished through: (1) counseling em)loyees on health practices; (2) providing annual screening tests; and (3) =idministering first aid and emergency service. The purpose of the screening tests is to aid both the employee and his private physician in evaluating the health status of the employee. These tests include checking weight, blood pressure, vision and hearing, plus a chest x-ray, urinalysis, hemoglobin, white blood cell count, serology, and blood typing. After a lapse of about two years, blood sugar determination was added as a routine screening test in March, 1962. Medical care beyond first aid, is not offered because the Service is designed to motivate employees to assume the responsibility for their own health, and seek medical evaluation and treatment from their private physician.
In January, 1962, the part-time physician resigned and was replaced by a full-time physician. In addition the staff consists of two nurses, two medical technicians, and two secretaries.
Among the 1, 185 employees screened in fiscal year 1962, 945 previously unknown and 313 known abnormalities were recorded. The
- 69 -

majority of these conditions were overweight and defective hearing and

vision. Thirty-nine employees with previously unknown and six with

known hypertension were referred to their private physician for evaluation.

Abnormal hemoglobins were detected in 37 employees, and there were 34

abnormal urinalyses. These conditions were made known to the employee

with the recommendation that he seek medical interpretation from his

private physician. Visits and emergency calls for calendar years 1959

and 1960, and fiscal year 1962 are tabulated below:

1959

1960

1962

Screenings New screenings Repeat screenings
Screening revisits Counseling and First Aid bnmunizations Other Total Visits Health Literature picked up

1500 344
1156
2985 826 524
5835 2892

1600 420
1180 1397 4401 346
377 8121 3448

1186 222 964
1146 6409 6957*
86 15, 7 84
5400

>!<Includes influenza immunizations Fall of 1961

Although the law concerning physical examinations of State employees was again amended in early 1962, the State Employees Health Service remains as the State 1s Medical Consultant to review reports of findings of preemployment physical examinations. Operations have not begun under this law, however, the physician-in-charge is consulted to review reports of findings of examinations for certain job classifications.
During September 840 state employees were screened in a pilot

- 70 -

glaucoma project sponsored by the Georgia Society for the Prevention of Blindness, Fulton County Medical Society, Medical Association of Georgia, and the Georgia Department of Public Health. Eighteen screenees were referred to physicians. Diagnostic follow-up revealed four to be chronic simple glaucoma, eight possible glaucoma, and six which were not glaucoma.
- 71 -

OCCUPATIONAL HEALTH SERVICE
The primary function of the Occupational Health Service is to protect the health of all employed people in Georgia through the promotion of good health practices, provision of a consultation service to private physicians, local health departments, management, and insurance carriers, plus a preventive health service for state employees,
The staff consists of nine members: two physicians, two nurses, two medical technicians, and three secretaries, Seven of these staff members are employed in the State Employees Health Service,
There is considerable under reporting of occupational diseases and conditions since the only sources of information are the insurance claims submitted to the Workmen's Compensation Board, and death certificates filed with the Vital Records Service. During fiscal year 1962, five of the deaths reported were due to silicosis as a contributory cause, and one to pneumoconiosis,
Occupational disease claims filed with the Workmen's Compensation Board totaled 442. These reports were from 299 employers in 72 counties, and five out-of-state employers in five states, These reported conditions were as follows: dermatitis - 276; chemical injuries - 43; possible lead intoxication - one; conditions due to fumes and gases - 61; carbon monoxide poisoning -two; undulant fever - one; and actinic ray ophthalmia two.
- 72 -

These data are utilized.for study in an effort to determine the best methods of control. When indicated, local health departments are notified of the occurrence of occupation related mortality and morbidity and offered assistance in follow up. This assistance includes both the medical and engineering aspects of field investigations. The latter is provided by the Industrial Hygiene Service and includes dust counts, air analyses, noise level determinations, and radiation detection plus a general evaluation of the total environment of the place of work.
The research program in the kaolin industries continued in the form of completing pulmonary function studies, interpretation of chest x-rays, and statistical correlation of findings. This project terminates in August, 1962.
The Director and Occupational Nurse Consultant continued to actively participate in national, state, and local meetings and seminars concerned with occupational health. Cooperation with schools of medicine and nursing has been maintained through participation in lectures and conferences. A medical student was trained and oriented for the su.mmer months while working in the Employees Health Service.
- 73 -

TUBERCULOSIS CONTROL SERVICE (Also see Battey State Hospital Report)
The Tuberculosis Control Service provided consultation, advice and assistance to county health departments in response to their requests.
The Tuberculosis Nurse Consultant made visits to 55 counties in connection with: planning and evaluating the diagnostic and evaluation clinic services; reviewing local tuberculosis case registers and editing their reports; contributing to local and district staff educational programs; participating in public programs; assisting local agencies in developing programs for school tuberculin surveys and recording results; making case load surveys, home visits, and record evaluations with local public health nurses.
The Rehabilitation Consultant assisted many county health departments in locating infectious recalcitrant cases and returning them to treatment, utilizing commitment by court order when indicated.
X-ray services were expanded. One-third of the county health departments requested one or more additional x-ray clinics. The number of persons attending these clinics is increasing.
Free drugs were furnished to complete treatment begun in tuberculosis hospitals, to institute chemotherapy without hospitalization in selected cases, and for chemoprophylaxis of persons who fall into eligible categories.
Cooperative efforts to find tuberculosis among state prisoners
- 74 -

proved rewarding. During a 12 month period, more than 100 prisoners were sent to Battey State Hospital for diagnostic study and treatment.
An additional evaluation center was established in Cordele to provide competent medical advice to seven health departments in that area in managing their problem cases.
The Pilot Study Project was continued in Bibb, Jones and Twiggs counties. During the period October, 1960 through September, 1961, the joint efforts of public health nurses, health investigators, the clinic staff, and all other contributing forces, both public and private, achieved performances in case detection which surpassed the standards set by the Ad Hoc Committee. Thirty-one additional new active cases of tuberculosis were discovered.
Considerable success was achieved in bringing back to supervision 56 cases that were referred for follow-up. Information on the status and final disposition of suspects and contacts of tuberculosis cases is kept current in the project area through the use of a multiple epidemiologic form. This study indicates that health investigators are an effective means of strengthening the epidemiologic approach to tuberculosis control.
On March 1, 1962, the Tuberculosis Control Pilot Project was expanded to include an additional 31 counties in central Georgia through special project funds provided by the U. S. Public Health Service. Three health investigators, one public health nurse consultant, and two stenographers were added to the already existing staff of two health investigators
- 75 -

and a clerk. Emphasis is being placed on intensified services to tuberculosis patients, suspects and contacts in the project area.
There was an over all increase of 24. 1 o/o in new cases recorded during this 12 month period, with an increase of 8. 3o/o in Group A (Active and Probably Active). This increase may be due to some degree to a difference in reporting. There was a slight decrease in the number of deaths (14), a rate of 4. 9 per hundred thousand as compared with 5. 3 per hundred thousand for the previous year.
- 76 -

VENEREAL DISEASE CONTROL SECTION
Previously Untreated Venereal Disease Cases Reported The 3, 549 cases of total syphilis reported for fiscal 1962 shows
an eight per cent decrease from total syphilis cases reported for fiscal 1961.
The 946 cases of primary and secondary syphilis reported for fiscal 1962 shows a 16% decrease from P&S cases reported in fiscal 1961.
The 9, 910 cases of gonorrhea reported for fiscal 1962 shows a six per cent decrease from gonorrhea cases reported for fiscal 1961.
The 346 cases of other venereal disease (chancroid, GI, and LGV) reported for fiscal 1962 shows a four per cent increase over cases of other venereal diseases reported for fiscal 1961.
Our 16% decrease in primary and secondary syphilis cases for fiscal year 1962 as compared with fiscal 1961 is most encouraging since 1962 figures for the nation will again show a marked increase in primary and secondary syphilis rates. Health Investigation Program
Our Health Investigators completed 36, 357 investigations during fiscal 1962 as compared to 40, 700 investigations completed during fiscal 1961. From these investigations, 2, 741 previously unknown and untreated cases of venereal disease were brought to treatment. Of these, 872 were primary and secondary syphilis cases. This indicates that 90 plus per cent
- 77 -

of the total primary and secondary syphilis cases reported for the fiscal

year were brought to treatment through the Health Investigation Program.

The decrease in number of total investigations completed during

fiscal 1962 as compared to fiscal 1961 is because of de-emphasis on the

epidemiology of gonorrhea and concentration on the epidemiology of early

infectious syphilis.

Of the 946 cases of primary and secondary syphilis reported for

fiscal 1962, 946 (lOOo/o) were interviewed for contacts, suspects and

associates by our Health Investigators.

All reactive serologic specimens processed in public health, hospi-

tal, and private laboratories during fiscal 1962 were followed-up by our

Health Investigators.

Diagnostic and Treatment Services

During fiscal 1962 the private physicians of Georgia treated 60% of

our total reported syphilis cases; 25% of the reported primary and second..

ary syphilis cases; eight per cent of the reported gonorrhea cases; and one

per cent of the other venereal disease (chancroid, GI, and LGV) cases

reported. During fiscal 1962 our Area VD Diagnostic and Treatment

Centers treated 40% of the total syphilis cases reported; 7 5% of the pri-

mary and secondary syphilis cases reported; 92% of the reported gonorrhea

cases; and 99o/o.of the reported cases of other VD.

The private physicians of Georgia have met their responsibility as

a partner with public health in the diagnosis and treatment of venereal

diseases.

- 78 -

VETERINARY PUBLIC HEALTH
Veterinary public health activities have continued to develop as a part of the general epidemiology program. Major interests are directed toward the ecology of the zoonoses of special public health interest and importance in Gear gia.
The incidence of animal rabies continues to remain at an all-time low. Reported cases have occurred sporadically in a variety of wildlife and domestic animal species, mainly in the lower third of the State. It is of special note that rabies in foxes, the classical wildlife vector of rabies in the Southeastern United States, has not been reported since August, 1960 in Georgia. Furthermore, no sustained epizootic of rabies in any species has occurred in the State since early 1960.
Sporadic cases of rabies in bats continue to be reported from the metropolitan Atlanta area. Two free-living species have been principally involved; the red bat, Lasiurus b. borealis, and the hoary bat, Lasiurus cine reus.
Studies on the ecology of the atypical Mycobacteria in animals and their environment have proved very promising. Organisms characteristic of Group III non-photochromogens have been isolated from swine, cattle, and the environment of poultry. The role of the atypical Mycobacteria as a sensitizing organism to animal tuberculins will be explored in more detail in future investigations.
- 79 -

Incidental to studies of possible reptile hosts of endemic arthropodborne viruses in the Waycross area, a limited number of specimens have been cultured for Leptospira species. From one such specimen a cottonmouth moccasin (Agkistrodon piscivorus), Leptospira organisms were isolated. Representative cultures have been forwarded to the Communicable Disease Center for definitive typing.
In cooperation with the School of Veterinary Medicine, University of Georgia, and the Laboratory Branch, a continuing study on the relationship of animal staphylococci as a reservoir for human infections has been initiated. The incidence of staphylococcal disease has shown a sharp rise in veterinary students as their third and fourth year assignments increase the association with animals in the clinical area. "Hospital strains" of staphylococci have repeatedly been recovered from cultures of lesions and from the anterior nares of students. Similar strains have also been recovered from the clinical environment.
The utilization of practicing veterinarians in all areas of the State as consultants and participants in health related activities continues successfully.
- 80 -

\ ,,.

\
'.

i.

l ,,

special services branch

BATTEY STATE HOSPITAL
During the past fiscal year applications for admittance to the hospital increased from 1, 732 to 1, 880. All applications were carefully reviewed and 64 (3. 4%) were rejected on the basis that the applicants did not need hospitalization.
The number of admissions increased from 1, 588 to 1, 754 (or 10%). One thousand, seven hundred ninety-two admissions in 1959 was the largest number of admissions in one year. Of the patients admitted to the hospital l, 028 were white and 726 were Negro. Diagnosis made at the time of admission revealed the following: 30% of the patients had far advanced tuberculosis; 35% had moderately advanced disease; five per cent had primary tuberculosis; 11% had minimal tuberculosis; four per cent had other forms of tuberculosis; and 15% did not have the disease. There was very little change in the admission diagnoses except for a five per cent decrease in far advanced tuberculosis and a four and a half per cent increase in the number that was proven not to be tuberculosis.
There were 1, 297 (74%) patients admitted for the first time, while 457 (26%) were readmissions. Only l, 050 of those admitted for the first time had tuberculosis.
More persons in the older age groups are being admitted to the hospital. In 1950, 10% of the patients were 60 years of age and over, while in the past fiscal year 25% were over 60.
There was nQ waiting list during the year and every emergency
- 81 -

patient was promptly admitted. One in every six admissions was an emergency. Of the 1, 754 admissions, 1, 004 (57%) came from 18 of the counties in the state.
A successful treatment program can be anticipated in 95%, or more, of the patients admitted for the first time, if they remain in the hospital until they receive a medical discharge. This includes treatment with the various drugs available. About 10% of the patients will need thoracic surgery. Extensive work is being carried out with new drugs in a controlled research program.
Careful attention is being given to the problem of drug resistance, both at the time of admission and at the time of discharge. Local health authorities are notified when any drug resistant patient is discharged so that public health control of patients in this category can be expedited.
The patient load at present is 77 3. During the past year 1, 859 were discharged; an increase of 246 (13%) from the number discharged in 19601961. Of the 1, 859 discharged, 218 (11. 7%) were discharged against the advice of the physician. In regard to irregular discharges, this is the best record we have ever attained. We had only four disciplinary discharges. Twenty-three of the 791 Negro patients (3%) received irregular discharges. Nineteen per cent of the white male discharges were irregular. Fifteen per cent of the white female discharges were irregular. The average length of stay in the hospital for a patient with tuberculosis was 207 days; for those who were non-tuberculous, the average stay was 41 days. The
- 82 -

average stay for all patients was 182 days, a decrease of 30 days from the fiscal year 1960-1961.
The employee-patient ratio remains approximately 1:1 and the per diem cost per patient is $13. 15.
The most pressing need is for a modern hospital about one hal the size of the temporary one now in use. The present hospital is not only out-moded and unfunctional but extremely expensive to maintain.
- 83 -

HOSPITAL SERVICES
During 1961, Hospital Services continued to maintain a comprehensive program of assistance to local communities in order to improve patient care facilities and services. This assistance was provided through the following organized programs: (1) Community Survey and Planning Program to aid communities in planning for expanded and improved medical care facility service; (2) Architectural-Engineering and Equipment Program to review and approve plans and specifications to assure the construction of efficient, safe, and properly equipped facilities; (3) Hospital Licensure Program to inspect and encourage hospitals to meet standards established under the Georgia Hospital Regulations Act; (4) Nursing Home Services Program to assist communities in support of more adequate facilities and services for the care of long-term patients; (5) Consultation and educational services to advise administrators and governing boards with special operational and community problems.
Activities in the construction program continued a similar trend as in previous years. Appropriations have remained about the same; however, the amount of construction and the number of projects decreased slightly during the year due to increased construction costs and larger size projects. The backlog of applications waiting approval continued to increase during the year, as 33 applications now are pending for grant-inaid funds at an estimated cost of $48, 225, 000. 00.
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Grant projects approved during fiscal year 1962 were as follows:

TYPE PROJECT

NUMBER BEDS

TOTAL COST

Hospitals Nurse Training Health Centers Diagnostic-Treatment Centers Rehabilitation Centers Nursing Homes

8

476

$9,473, 091. 12

1

l, 380, ooo. 00

1

83, 892. 00

2

763, 000. 00

1

1, 455, 000. 00

1

30

343, 600. 00

TOTAL

14

506

$13, 498, 583. 12

The Community Hospital Planning Section projects included: increased planning in urbanized areas for expanded facilities; more activity relating to area wide planning through hospital councils in five areas (Athens, Atlanta, Augusta, Columbus, and Savannah); similar councils are in the process of being developed in Albany and Macon. During the year the staff placed more exacting requirements relating to the development of program narratives by project sponsors prior to consideration for grantin-aid approval.
The Construction Section reviewed for approval all plans and specifications for Hill-Burton projects; in addition, the Section reviewed all plans submitted for licensure purpose for hospital, nursing homes, and homes for the aged. Considerable assistance was given to the review of plans, equipment, and cost estimates for state construction projects at Milledgeville State Hospital, Gracewood, and Georgia Mental Health Center, Atlanta.
In nursing home licensure, the Rules and Regulations for Nursing

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Homes and Related Institutions were revised and distributed. The new regulations include a classification system; facilities are identified as "medical care homes", 11 skilled nursing homes 11 , and 11personal care homes". On June 30, 1961, there were 176 nursing homes and homes for the aged in Georgia, with 113 approved. At the close of this fiscal year, the homes numbered 17 5 and 131 were approved.
The Hospital Standards Section reported upward improvement in the quality of hospital facilities and services in the State. During the year, 14 additional full approval licensure permits were issued to hospitals; currently the total in compliance with licensure standards number 142. Some 70 hospitals were operating with provisional permits, the majority of which have serious physical plant problems to overcome. Several hospitals are making improvements and six are scheduled to close when replacement facilities, now under construction, are completed.
In this reporting period, the consultation staff worked with hospitals and related facilities in providing consultation to department heads, administrators, and governing boards with special operational problems. The dietary consultant assisted in the development of a correspondence course for food service personnel, and reviewed plans for food service in new facilities. The laboratory technologist presented two one-day seminars on hospital infections and also visited eye-banks and participated in the drafting of proposed rules and regulations for eye-banks in Georgia.
The equipment consultants assisted 47 medical facilities in matters
- 86 -

relating to equipment selection and procurement. A nursing consultant with special training in rehabilitation was employed to help hospital and nursing home staffs become more effective in the rehabilitation of the aged and other disabled patients. The accounting consultant advised hospitals with financial problems and supervised the publication of monthly financial data in Hospital Notes.
- 87 -

Division of Mental Health

ALCOHOLIC REHABILITATION SERVICE
We expanded our treatment service to include group therapy for Negroes, and increased our training activities to include leaders on the community level who can be helpful to the alcoholic and his family.
The Georgian Clinic in Atlanta and the Chatham Clinic in Savannah provided the following services to patients from 141 counties.
Georgian Clinic: 279 resident patients for a total of 12, 702 patient days. 208 were new admissions and 38 re-admissions.
l, 005 day-care patients for a total of 17, 469 visits with 89, 733 services rendered.
1, 734 family visits for consultation and family groups. Chatham Clinic:
244 day-care patients for a total of 4, 7 52 visits. 47 5 family visits for consultation. 23, 584 day-patient services rendered.
Recovery of patients remained near 66 2/3o/o. The number of inactive patients (who have received treatment in past years) making payments on their accounts is most encouraging, and reveals that many patients with whom we have had no contact for a number of years are progressing to the point that they are able to make these payments. Payments are small in most cases, but they indicate the patient is working and able to assume financial responsibility for treatment.
Plans have been written and budget prepared to expand our Service to include development of a program to provide treatment, consultation,
- 88 -

and follow-up through local health offices. The helping professions are seeking training and orientation in
alcoholism, which has necessitated more emphasis on teaching and training. Thirty-three vocational rehabilitation counselors and six probation officers received orientation at the Georgian Clinic. This resulted in a cooperative working agreement with the Vocational Rehabilitation Service to provide treatment to their clients. This relationship will benefit both Services, and is a step toward helping alcoholics to reestablish themselves in the community, as well as developing more local resources.
Staff members served on school faculties, participated in seminars and institutes, and spoke to numerous professional and lay groups.
Four faculty members and 31 students from Georgia attended the Southeastern School of Alcohol Studies. The School will be held at the University of Georgia in 1963 and 1964.
Demands for factual and scientific information increased as evidenced by the numerous requests for lay and professional booklets. We continue to publish "The New Life" and also participated in radio and television programs throughout the State, particularly during "Alcoholism Week". As a result there were hundreds of telephone calls and letters asking for additional information.
A study, "Follow-up Standards in Alcoholism Out-patient Clinics'', at Chatham Clinic, was completed and is being prepared for publication.
- 89 -

A training program, ttModifying Medical Residents 1 Attitudes on Alcoholism", is still in progress, and permission has been granted to include public health officers. The "Closed Psychotherapy Group for Couples 11 is entering its fifth year, and appreciable changes are observed in all members. New drugs for the management of withdrawal symptoms and maintaining "sober" alcoholics are continually evaluated, and some are effective for both the patient and hospitals admitting patients in acute stages.
- 90 -

COMMUNITY MENTAL HEALTH SERVICE
Local Health Department Mental Health Services Nine counties employed mental health personnel for the operation of combined clinic and consultation services (Bibb, Chatham, Cobb, DeKalb, Dougherty, Floyd, Fulton, Glynn, and Muscogee). Two additional counties (Clarke and Hall) set up budgets and planned programs. Only one local program included an entire health district (No. 34: Bibb, Jones, Twiggs). A special project on juvenile delinquency and a professional development conference on small group approaches in community mental health involved these local programs.
Nursing Services As this program went into its lOth year it was operating on a statewide basis. Orientation of new nurses at Milledgeville State Hospital continued, and both medical school psychiatric services (Talmadge Memorial in Augusta and Grady Memorial in Atlanta) offered four-day orientation courses for small groups of nurses about once a month. The In-service Education Series (five one-day sessions) were held in 14 health districts for nurses from 55 counties.
Interagency Cooperation in Studying Community Mental Health Needs and Resources In August a workshop on emotional factors in school absenteeism involved both Health and Education Department personnel. Representatives
- 91 -

from health departments and mental health associations from 30 counties met in a state-level conference in February, 1962 to plan cooperative efforts in spearheading local interagency coordination of effort in developing mental health programs. Emphasis was placed on more specific description of units of program activity. This joint effort will enhance a variety of cooperative activities with other agencies at state and local level as progress is made on the portion of the program that emphasizes community resource reinforcement.

Community Hospital Psychiatric Program

For the fifth year the Georgia Department of Public Health continued

to purchase service from four general hospital psychiatric services for

voluntary mental patients referred from local health departments. The

totals for four and a half years operation, thru June 30, 1962, included

2, 238 first admissions from 156 of Georgia's 159 counties. During the

fiscal year patients were admitted from 125 counties, with the following

totals:

Talmadge Memorial, Augusta Columbus Medical Center Macon Hospital Grady Memorial, Atlanta

Applications
286 165 125 344

First

Total

Admissions Patient Days

17 5

6545

150

3666

122

3609

128

6110

Total

920

575

19,930

Outpatient clinics were supported in Phoebe Putney Memorial

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Hospital, Albany one morning a week, and once or twice a month at Athens General Hospital, Athens, in hope of speeding development of in-patient psychiatric services, and to fill gaps in existing services.
Meetings with combined medical staffs and medical societies were held in Albany, Athens, and Dalton with representatives from state and local health departments, one or more of the Community Hospital Psychiatric Program hospitals, and Milledgeville State Hospital. This program made possible 18 of the 31 psychiatric residency positions at the two medical schools.
Orientation programs for public health nurses (in groups of four to six for four days) were held at both medical school centers (Talmadge Memorial and Grady Memorial).
A special pilot project included interviews with over 100 physicians i.n 11 general hospitals throughout the state, aimed at getting more adequate information on services now being rendered and the likelihood of developing psychiatric services in more general hospitals in Georgia.
A close working relationship was continued with the Georgia Hospital Association and various professional groups.
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GRACEWOOD STATE SCHOOL AND HOSPITAL
The public focus on the problem of mental retardation has been heightened in Georgia by the creation of President Kennedy's Panel on Mental Retardation and the emphasis placed on the Gracewood Angel program by the Georgia Federation of Women's Clubs. But increased public awareness brings with it increased public pressure for material help to the retarded individual. Gracewood, with its intensive program providing for both custodial retardates and those with potential for rehabilitation, now has a waiting list which has swelled to 1, 196 applicants. The need for developing adequate community resources for the retarded has never been more acute.
Resident Population - The net increase of residents during the fiscal year numbered 109. However, there were 193 new admissions during this period. With the completion of buildings in the Negro division and expansion of the program there, 48 or 25 of all new admissions were Negro retardates.
The establishment of a vocational rehabilitation program accounted for some of the movement of Gracewood residents. The division of Vocational Rehabilitation in the State Department of Education contracted with Gracewood to furnish a counselor on half-time basis, beginning September 1, 1961. Working with the various departments to discover Gracewood residents who have good vocational potential, the counselor has made 37
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placeinents. It is expected that the vocational rehabilitation staff and activities will be increased when the facilities of the Out-patient Rehabilitation Center become available.

The following charts give a break-down of the resident program and the population movement.

A. Admissions, Discharges, and Deaths, by race and sex Gracewood State School and Hospital July 1, 1961 - June 30, 1962

Item
Admissions Discharges Deaths

Total
193 73 ll

White

Non-white

Male Female Male Female

91

54

34

14

43

29

l

0

3

6

l

l

B. Total Population, by race, sex, and age Gracewood State School and Hospital June 30, 1962

Age Group in Years

Total

White

Non-white

Male Female Male Female

Total all ages
0- 5 6- 9 10 - 14 15 - 20 21 and over

l, 622

835

38

20

151

80

338

168

521

283

574

284

697

60

30

12

5

l

43

21

7

138

14

18

215

19

4

289

l

0

Out-patient Services - In addition to the care, treatment, and therapies given to the Gracewood in-patient population, approximately 254 mental retardates and their families were seen as out-patients. Services to these out-patients ranged from counseling interview and tour of the

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institution to medical examinations and diagnoses. The completion of the Out-patient Rehabilitation Center will significantly expand this important service.
New Construction and Improvements - Construction on the 300-bed infirmary facility has been completed, while const:.. uction was begun on the Out-patient Rehabilitation Center during the fiscal year. Other building programs include the water systems improvements with the addition of the fluoridation program; a curbing and paving program with part of the work being furnished by prison labor; renovation of an old building into downstairs space for a spacious canteen for the residents and upstairs space for four classrooms to be used for the trainable mentally retarded. A continual program of renovation and campus improvement is carried on by the Maintenance Department.
Personnel Report - There was a personnel increase from 450 employees to 496 during the fiscal year. Emphasis has been placed on employing better qualified personnel, and a news bulletin program has been instituted to keep the employees better informed and to maintain good morale. The personnel turnover dropped from the 1960 - 1961 percentage of 31.64 to 21.5 per cent in 1961 - 1962. Increased salaries for the lower pay bracket personnel and the leveling off of the longer service employees help to account for the smaller turnover.
In preparation for the staffing of the new infirmary building most of the screening and selection of employees has been completed. Due to
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budgetary limitations, the staff for this new facility was cut from the 192 additional employees called for by the original plans to 82 employees.
Addition of supervisory staff to the nursing division, cottage life department, and culinary department has resulted in wider and more efficient service in these areas.
Public Information Program - There were more than 5, 000 visitors to Gracewood during the year. Among them were college groups, public health personnel, and civic organizations. The State Board of Health met at Gracewood in regular session. The Georgia Association of Retarded Children held a quarterly meeting on the campus. The Board of Directors of the Georgia Parent-Teacher Association toured the institution. A South Carolina Association for Retarded Children group also visited Gracewood.
With the appointment of a Public Relations representative on January 1, Gracewood is expanding its attempts to provide information about mental retardation and the institutional program. The representative works with both lay and professional groups.
Research Projects - The Gracewood Medical department has undertaken a number of research projects: (1) Rovamycine-Diphetarsone in the treatment of shigellosis, (Z) Infectious hepatitis and gamma globulin, (3) Biochemical defects in mentally retarded children, (4) Chromosome analysis and congenital cerebral maldevelopment, (5) Virus disease as a possible etiologic factor as the cause of mental retardation, and (6)
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Epidemiology and toxoplasmosis (in cooperation with personnel of the Gracewood farm.)
Special Projects - In sooperation with the Southern Regional Education Board and institutions in 14 other southern states, Gracewood has been working on a prog.cam which is designed to offer better training to attendant personnel. Following the preliminary work and evaluation which a committee on attendant training has now completed, Gracewood expects to move into an effective training program.
The Gracewood staff has cooperated with legislative committees and the State Department of Public Health in doing preliminary surveys and planning for a second institution for the mentally retarded.
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MILLEDGEVILLE STATE HOSPITAL
Milledgeville State Hospital continued to improve and expand its therapy program and to develop better physical facilities for patient care and treatment during 1962.
After three years operation under the Department of Public Health, the instltution is now beginning to emerge as a treatment facility equal to any state mental hospital in the country. New admissions have increased 44% in the last two years. We are now admitting approximately 500 new patients monthly, six out of ten of which are being discharged within 90 days and eight out of ten within the year. At the date of this report all professional departments with the exception of one are meeting the accreditation standards of the National Associations and are headed by competent and fully accredited individuals.
It should be emphasized that the tremendous increase in new patients entering the institution on voluntary commitments as well as under the 1960 Law is a criterion of increased confidence on the part of the people of Georgia in the hospital's treatment program and is also evidence of a better under standing of the needs of the mentally ill.
A start was made in January on the division of the institution into 2, 000 bed units by the organization of a geriatric unit. Experience gained in the creation of this initial unit will be of great value in the organization of the seven additional units. The organization of Unit Six, the geriatric
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unit, has demonstrated that the unit plan is entirely feasible in this institution and will result in a more cohesive achninistrative pattern, better care and treatment for the patients, a closer working relationship between the members of the treatment teams as well as the general employee staff, better maintenance of the physical plant and equipment, and more rapid elimination of trouble spots and areas of difficulty when these arise. The plan also permits a certain flexibility in the therapy program since each unit director will operate his unit as a therapy hospital within the framework of the general policy laid down by the superintendent while at the same time maintaining high standards of medical practice.
Some construction difficulties have arisen in the $6, 500, 000 building program; however, these have been ironed out and we expect all of these buildings to be completed and ready for use by approxi~ately January l, 1963. As of this date the 500 bed Yarbrough Rehabilitation Center is three -fourths completed as is the 660 bed addition to the Arnall building and the central kitchen. The staff dormitory and apartment building is now complete and personnel will begin moving into the new quarters within the next several months. Relocation of the shops and garages back of the Powell building is in the planning stage and will be effected as rapidly as possible. With the completion of these buildings the institution will be on a par with any state mental hospital of its size in the country.
Eight new physicians have joined our staff. However, we are still far below the American Psychiatric Association recommendation in the
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number of physicians necessary to provide an effective program of therapy throughout the hospital. It is our hope that additional funds will be made available by the General Assembly during the coming biennium so that some of these positions so vitally needed may be filled.
We are still in desperate need of outstanding men to fill the positions of Director of Education, Director of Psychiatry, Director of Unit Operations, Chief of Neurology, Director of Ancillary Services, and several other positions. In addition we badly need competent Board Eligible or Board Certified psychiatrists with administrative experience to head up the six units which will be organized within the next year. If the unit system is to function as originally planned, competent men must be secured for these positions.
The per diem cost to the state for the operation of Milledgeville State Hospital for fiscal year 1962 has risen to $3. 29 as compared to a per diem cost of $2.78 for fiscal year 1961. In round figures the total cost of operation of this institution for the past year was $15, 867, 000 or a per diem cost for the total operation of $3. 65 per patient per day. While we are gradually approaching the national average of $5 per patient per day, we have not yet arrived at this minimum figure. To do so will take a budget approximately $21, 000, 000.
Employee-patient ratio is now 1:4. 62. It is possible that with the creation of the unit system and the need for the staffing of additional positions resulting therefrom, there will be some discrepancy in this figure;
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however, we are still below the ideal standard of l: l. Additional positions are badly needed throughout the entire institution.
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Special Programs

CIVIL DEFENSE HEALTH SERVICES
Productive Civil Defense Health Service activity will, in the event of a widespread national disaster, be almost entirely on the local level. Attention has therefore been concentrated toward assisting local physicians, hospital administrators, nurses and other ancillary personnel in matters pertaining to more efficient and better coordinated local emergency medical services.
A great amount of time has been spent in an effort to assure that both the local health departments and the community hospitals have disaster plans that are coordinated with the health services annexes of the political subdivisions and that all plans are basically consistent with the State and Federal plans.
On June 15 a meeting of all District Directors of Public Health was held in the offices of the Medical Association of Georgia to discuss "Professional Responsibilities in Disaster Health Services. " The meeting was under the joint sponsorship of the Georgia Department of Public Health, the Regional Office of Health Mobilization, the Medical Association of Georgia, and the Local Health Officers Association of the State.
The June 15 meeting helped strengthen the policy of the Georgia Civil Defense Organization that all Health Annexes and RADEF Annexes require initial signed approval by the Director of the Health District encompassing the jurisdiction submitting the annex. Those political subdivisions not within an "activated health district" must submit their
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annexes to the Regional Health Director for approval. This plan allows the State Director of Civil Defense Health Services the most desirable type of assistance in determining completeness and workability which is the basic criterion for final official approval. Marked improvement in the quality and completeness of annexes resulted from this improved procedure.
Statewide coverage for Georgia's initially assigned 68 Medical Self-Help Kits has been attained by distribution on a basis of one kit per 50, 000 population, to those health districts of Georgia with Medical Directors. Milledgeville State Hospital, Battey State Hospital and the Gracewood State School and Hospital are also participating in this initial phase of the Medical Self-Help Program. We have also had excellent cooperation from the Dental School of Emory University and the Emory University School of Nursing.
Arrangements were completed before the end of the year for a very complete technical inspection of all Civil Defense Emergency Hospitals presently pre-positioned in Georgia. This inspection is scheduled to begin on July 9 and will be carried out by a specially trained team representing GSA. Georgia presently has 26 pre-positioned 200 bed hospitals plus two stored training hospitals. Arrangements are being made to increase their stocks of supplies from the present three to four day potential to a 30 day potential. This anticipated revamping should be fully completed by sometime in 1964.

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. ~
GERIATRICS PROGRAM
The three areas of planning and program activity of the Geriatrics Program during this fiscal year included: continuation of the Task Force on Geriatrics for coordinated planning; the Cooperative Study Plan with district health officers for correction of deficiencies in a geriatrics program; and the instigation and early operation of an Organized Home Services Program in Whitfield County.
Task Force Planning - Through sub-committees chaired by Task Force members, three subject areas were explored and progress was made in attaining proposed objectives, namely; local program development; intra-departmental cooperation and program service exploration and cooperation; and coordination with state agencies and voluntary organizations.
Organized Home Services Program for the Chronically Ill and Aged - In the summer of 1961, developmental plans were begun for a cooperative program between Dalton-Whitfield County Health Department and Georgia Department of Public Health and for a cooperative project application grant through U. S. Public Health Service. This was set up on a three year sliding scale basis with anticipation of full assumption by the local health department at the end of this period.
The program, as a demonstration and a service-giving source, would eventually encompass such elements as medical supervision, nursing care, social work services, homemaker service, nutrition counselling and service, mental health counselling, volunteer friendly visiting and home
- l 05 -

facilities survey. The project was approved and functioning by February, 1962. The original staff included seven employees - one public health nurse, three licensed practical nurses, two homemakers. and one secretary. At the close of the fiscal year, 42 patients had been accepted into the program and 87 5 home visits made by assigned staff. A thorough job of orientation was completed by the entire staff, including potential volunteer s.
Cooperative Study Plan with District Health Officers - The Consultant on Geriatrics in conjunction with members of the Health Conservation Branch participated in a joint review of deficiencies and weaknesses in the geriatrics program and a proposed plan of action. This was based on an earlier review and evaluation carried out in 18 counties by the Branch. Conclusions reached included: the need for education and dissemination of information regarding health and health related aspects of aging; demonstration projects such as the Organized Home Services Project, "Well Oldster" clinics, diagnostic centers and group training of older persons in self care; increased staff for increased program activities; and further utilization of special grant funds for demonstrations on local levels.
General Information - During the period July l, 1961 to April l, 1962, the staff of this unit included the Consultant on Geriatrics and one stenographer. On April l, 1962, these employees resigned to accept employment with the Georgia Commission on Aging which began operation as a separate agency of the State government.
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By June 30, 1962, plans were completed for the establishment of Special Services Branch of the State Health Department which would include the Geriatrics Program with a full-time medical director for Chronic illness and Geriatrics, one of the early recommendations of the Task Force.
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Front Cover (left to right)
Surgeon, 14th Century Physician, 16th Century Physician, 17th Century

Back Cover (left to right)
Greek Physician Physician of Rome During the Empire Surgeon, 16th Century Army Surgeon of N apoleonic Era

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